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Probe-based confocal laser endomicroscopy in the margin delineation of early gastric cancer for endoscopic submucosal dissection

 Jun Chul Park  ;  Yehyun Park  ;  Hyun Ki Kim  ;  Jeong‐Hyeon Jo  ;  Chan Hyuk Park  ;  Eun Hye Kim  ;  Da Hyun Jung  ;  Hyunsoo Chung  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Yong Chan Lee 
 Journal of Gastroenterology and Hepatology, Vol.32(5) : 1046-1054, 2017 
Journal Title
 Journal of Gastroenterology and Hepatology 
Issue Date
Adult ; Aged ; Aged, 80 and over ; Female ; Gastric Mucosa/diagnostic imaging* ; Gastric Mucosa/pathology ; Gastric Mucosa/surgery* ; Gastroscopy/instrumentation* ; Gastroscopy/methods* ; Humans ; Male ; Margins of Excision* ; Microscopy, Confocal* ; Middle Aged ; Prospective Studies ; Stomach Neoplasms/diagnostic imaging* ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery*
early gastric cancer ; endoscopic submucosal dissection ; probe-based confocal laser endomicroscopy
BACKGROUND AND AIM: We evaluated probe-based confocal laser endomicroscopy (pCLE) in the margin delineation of early gastric cancer (EGC) for endoscopic submucosal dissection in comparison with white-light imaging with chromoendoscopy (CE). METHODS: We conducted a prospective, randomized controlled study from November 2013 to October 2014 in a tertiary referral hospital. A total of 101 patients scheduled for endoscopic submucosal dissection due to differentiated EGC were randomized into pCLE and CE groups (pCLE 51, CE 50). Markings were made by electrocautery at the proximal and distal tumor margins, as determined by either pCLE or CE. The distance from the marking to the tumor margin was measured in the resected specimen histopathologically and was compared between the two groups by a linear mixed model. RESULTS: Among 104 lesions, 80 lesions with 149 markings (pCLE 68, CE 81) were analyzed after excluding undifferentiated EGCs (n = 8) and unidentifiable markings (n = 13). Although the complete resection rate showed no difference between the groups (94.6% vs 93.2%, P = 1.000), the median distance from the marking to the margin was shorter in the pCLE group (1.3 vs 1.8 mm, P = 0.525) and the proportion of the distance <1 mm was higher (43.9% vs 27.6%, P = 0.023) in the pCLE group. Finally, subgroup analysis with superficial flat lesions (18 lesions, 31 marking dots) showed a significantly decreased distance in the pCLE group (0.5 vs 3.1 mm, P = 0.007). CONCLUSIONS: Among EGCs with superficial flat morphology, in which the accurate evaluation of lateral extent is difficult with CE, pCLE would be useful for more precise margin delineation.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
김은혜(Kim, Eun Hye) ORCID logo https://orcid.org/0000-0001-6691-6837
김현기(Kim, Hyunki) ORCID logo https://orcid.org/0000-0003-2292-5584
박예현(Park, Yehyun) ORCID logo https://orcid.org/0000-0001-8811-0631
박준철(Park, Jun Chul) ORCID logo https://orcid.org/0000-0001-8018-0010
신성관(Shin, Sung Kwan)
이상길(Lee, Sang Kil) ORCID logo https://orcid.org/0000-0002-0721-0364
이용찬(Lee, Yong Chan)
정다현(Jung, Da Hyun)
정현수(Chung, Hyun Soo)
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