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Diagnosis of Clinical Complete Response by Probe-Based Confocal Laser Endomicroscopy (pCLE) After Chemoradiation for Advanced Rectal Cancer.
Safatle-Ribeiro, Adriana Vaz; Marques, Carlos Frederico Sparapan; Pires, Clelma; Arraes, Lívia; Baba, Elisa Ryoka; Meirelles, Luciana; Kawaguti, Fábio Shigehissa; da Costa Martins, Bruno; Lenz, Luciano Tolentino; de Lima, Marcelo Simas; Gusmon-Oliveira, Carla Cristina; Ribeiro, Ulysses; Maluf-Filho, Fauze; Nahas, Sérgio Carlos.
Afiliação
  • Safatle-Ribeiro AV; Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil. adriana.safatle@hc.fm.usp.br.
  • Marques CFS; Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
  • Pires C; Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
  • Arraes L; Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
  • Baba ER; Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
  • Meirelles L; Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
  • Kawaguti FS; Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
  • da Costa Martins B; Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
  • Lenz LT; Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
  • de Lima MS; Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
  • Gusmon-Oliveira CC; Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
  • Ribeiro U; Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
  • Maluf-Filho F; Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
  • Nahas SC; Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, University of São Paulo School of Medicine (ICESP-HCFMUSP), Av. Dr. Enéas Carvalho de Aguiar, 255, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.
J Gastrointest Surg ; 25(2): 357-368, 2021 02.
Article em En | MEDLINE | ID: mdl-33443686
BACKGROUND: Neoadjuvant chemoradiotherapy (nCRxt) followed by radical surgery is the optimal treatment for advanced rectal adenocarcinoma. Patients with clinical complete response (cCR) may be followed closely without immediate surgery. Probe-based confocal laser endomicroscopy (pCLE) is a real-time in vivo method that allows acquisition of optical biopsies with 1000 times magnification, evaluating both epithelial and vascular patterns. AIM: To evaluate the role of pCLE in the diagnosis of cCR after nCRxt for advanced rectal adenocarcinoma. METHODS: pCLE was performed in 47 patients with locally advanced rectal adenocarcinoma (T3/T4, or N+) who underwent nCRxt (5-fluorouracil, 5040 cGy). RESULTS: Twenty-seven (57.5%) patients were men, and the mean age was 62.8 years. Thirty-seven had partial response confirmed by pCLE. Ten (21.3%) patients had good endoscopic response and presented small ulcer (n = 5) or residual scar (n = 5). After nCRxt, the essential features to differentiate malignancy from post-radiation alterations at pCLE were the presence of irregular crypts, budding, back-to-back glands, cribriform pattern, increased vessel/crypt ratio, and fluorescein leakage. A scoring system was created considering these epithelial and vascular features, with high accuracy for differentiating patients with complete response from those with residual neoplasia (p < 0.00001). pCLE sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100%, 71.4%, 95.2%, 100%, and 95.7%, respectively. CONCLUSIONS: (1) pCLE evaluation of epithelial and vascular features may improve the diagnosis of cCR and may alter patient management; (2) pCLE might be valuable for identifying patients with advanced rectal cancer who will benefit from watch and wait strategy, avoiding immediate surgical treatment.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Retais Tipo de estudo: Diagnostic_studies / Prognostic_studies Limite: Humans / Male / Middle aged Idioma: En Revista: J Gastrointest Surg Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Retais Tipo de estudo: Diagnostic_studies / Prognostic_studies Limite: Humans / Male / Middle aged Idioma: En Revista: J Gastrointest Surg Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos