title: Confocal laser endomicroscopy in breast surgery: a pilot study.
abstract: BACKGROUND
  Breast neoplasms include different histopathological entities, varying from benign tumors to highly aggressive cancers. Despite the key role of imaging, traditional histology is still required for a definitive diagnosis. Confocal Laser Endomicroscopy (CLE) is a new technique, which enables to obtain histopathological images in vivo, currently used in the diagnosis of gastrointestinal diseases. This is a single-center pilot feasibility study; the main aim is to describe the basic morphological patterns of Confocal Laser Endomicroscopy in normal breast tissue besides benign and malignant lesions.
  
  
  METHODS
  Thirteen female patients (mean age 52.7, range from 22 to 86) who underwent surgical resection for a palpable breast nodule were enrolled. CLE was performed soon after resection with the Cellvizio® Endomicroscopy System (Mauna Kea Technologies, Paris, France), by using a Coloflex UHD-type probe; intravenous fluorescein was used as contrast-enhancing agent. The surgical specimen was cut along the main axis; dynamic images were obtained and recorded using a hand-held probe directly applied both to the internal part of the lesion and to several areas of surrounding normal tissue. Each specimen was then sent for definitive histologic examination.
  
  
  RESULTS
  Histopathology revealed a benign lesion in six patients (46%), while a breast cancer was diagnosed in seven women (54%). Confocal laser endomicroscopy showed some peculiar morphological patterns. Normal breast tissue was characterized by a honeycomb appearance with regular, dark, round or hexagonal glandular lobules on a bright stroma background; tubular structures, representing ducts or blood vessels, were also visible in some frames. Benign lesions were characterized by a well-demarcated "slit-like" structure or by lobular structures in abundant bright stroma. Finally, breast cancer was characterized by a complete architectural subversion: ductal carcinoma was characterized by ill-defined structures, with dark borders and irregular ductal shape, formingribbons, tubules or nests; mucinous carcinoma showed smaller cells organized in clusters, floating in an amorphous extracellular matrix.
  
  
  CONCLUSIONS
  This is the first pilot study to investigate the potential role of confocal laser imaging as a diagnostic tool in breast diseases. Further studies are required to validate these results and establish the clinical impact of this technique.
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. giovanni.depalma@unina.it.
authors.forename: Giovanni D
authors.initials: GD
authors.lastname: De Palma
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. espodario83@gmail.com.
authors.forename: Dario
authors.initials: D
authors.lastname: Esposito
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. gaetano.luglio@gmail.com.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Luglio
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. glimite@unina.it.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Limite
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. antonello.accurso@unina.it.
authors.forename: Antonello
authors.initials: A
authors.lastname: Accurso
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. vivianasollazzo@gmail.com.
authors.forename: Viviana
authors.initials: V
authors.lastname: Sollazzo
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. francescomaione79@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maione
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. gian.cassese@studenti.unina.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Cassese
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. sicils@tin.it.
authors.forename: Saverio
authors.initials: S
authors.lastname: Siciliano
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. nicogenna74@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gennarelli
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. gennaro.ilardi@gmail.com.|Department of Advanced Biomedical Sciences, University of Naples Federico II. School of Medicine, Naples, Italy. gennaro.ilardi@gmail.com.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Ilardi
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. mariano.paternoster@unina.it.|Department of Advanced Biomedical Sciences, University of Naples Federico II. School of Medicine, Naples, Italy. mariano.paternoster@unina.it.
authors.forename: Mariano
authors.initials: M
authors.lastname: Paternoster
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. mariano.giglio@hotmail.it.
authors.forename: Mariano C
authors.initials: MC
authors.lastname: Giglio
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. forestie@unina.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Forestieri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology* / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010865:Pilot Projects; D011446:Prospective Studies; D055815:Young Adult