Abstract
For complete removal of cancerous tissue in esophageal squamous cell carcinoma (ESCC), intramural metastasis (IM) should be identified preoperatively or intraoperatively. Here, multiphoton microscopy (MPM) was introduced for label-free identification of IM in the esophageal wall, by a combination of two-photon excited fluorescence (TPEF), second harmonic generation (SHG) imaging, and spectral analysis. Three-dimensional (3D) imaging of the IM region was also performed. Quantitative parameters, including 3D fiber orientation, were measured by 3D-weighted orientation vector summation. Overall, MPM showed the potential to identify IM. With the development of the advanced MPM endoscope, clinical identification of IM by MPM will be possible.
Highlights
In surgeries for esophageal squamous cell carcinoma (ESCC), it is essential for the surgeons to completely remove the tumor tissue [1]
This would have the potential to improve the clinical outcome of ESCC, more normal tissue will be removed than is required in a case of no intramural metastasis (IM), leading to an abnormal esophageal function
3.1 2D optical identification of IM in the esophageal wall To investigate whether multiphoton microscopy (MPM) had the potential to histologically identify IMs in the esophageal wall, longitudinal frozen sections perpendicular to the esophageal layers were imaged
Summary
In surgeries for esophageal squamous cell carcinoma (ESCC), it is essential for the surgeons to completely remove the tumor tissue [1]. A study by Ide et al recommended a 5-cm resection margin because most IMs are found in a distance less than 5 cm from the primary tumor [5]. This would have the potential to improve the clinical outcome of ESCC, more normal tissue will be removed than is required in a case of no IM, leading to an abnormal esophageal function. In order to determine a curative surgical margin, accurate detection of IMs by an advanced preoperative or intraoperative detection technique is necessary
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