title: Feasibility and reliability of pancreatic cancer staging using a new confocal non-fluorescent microscopy probe: a double-blind study in rats.
abstract: Surgical management of pancreatic cancer depends on tumor resectability and staging. Lymph node (LN) metastases represent an important decision-making factor when it comes to surgical treatment.
  
  
  
  To evaluate a new in vivo, endoscopic confocal microscopy (CM) system not requiring fluorescence markers, for detection and staging of pancreatic cancer in rats.
  
  
  
  A confocal system consisting of a confocal scanning laser operating in reflection mode and a dedicated rigid Hopkins rod-lens endoscope were used for in vivo imaging in a rat model of pancreatic ductal adenocarcinoma. A double-blind study compared CM to standard histology in (1) the detection of tumors in rat bearing cancer (n = 11) and controls (n = 6), and (2) in the detection of local nodal involvement at 3 and 6 weeks after tumor induction.
  
  
  
  CM detected all pancreatic tumors with 100 % sensitivity and specificity and identified 15 metastatic LNs with an average adenocarcinoma nodule diameter of 2.3 mm (range from 1 to 4.2 mm) out of the 66 examined. CM demonstrated a sensitivity of 87.5 % and a specificity of 98 % in LN detection. The Spearman's rank correlation/rho calculator was of 0.87. CM demonstrated a negative predictive value of 96.1 % and a positive predictive value of 93.3 % in the detection of metastatic LNs.
  
  
  
  Interpretation of confocal images has a high concurrence rate with histopathology examination for primary tumor and lymphatic involvement detection making it a promising technique for in vivo real-time detection and staging of pancreatic cancer. Larger studies are warranted to confirm these preliminary results.
authors.affiliation: IRCAD-EITS, University Hospital of Strasbourg, 1 Place de l'Hôpital 1, 67091, Strasbourg, France. cherif.akladios@gmail.com.
authors.forename: Cherif
authors.initials: C
authors.lastname: Akladios
authors.affiliation: IRCAD-EITS, University Hospital of Strasbourg, 1 Place de l'Hôpital 1, 67091, Strasbourg, France.
authors.forename: Vivian
authors.initials: V
authors.lastname: De Ruijter
authors.affiliation: IRCAD-EITS, University Hospital of Strasbourg, 1 Place de l'Hôpital 1, 67091, Strasbourg, France.
authors.forename: Sylvana
authors.initials: S
authors.lastname: Perretta
authors.affiliation: IRCAD-EITS, University Hospital of Strasbourg, 1 Place de l'Hôpital 1, 67091, Strasbourg, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Aprahamian
authors.affiliation: IRCAD-EITS, University Hospital of Strasbourg, 1 Place de l'Hôpital 1, 67091, Strasbourg, France.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Ignat
authors.affiliation: Department of Pathology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Lindner
authors.affiliation: Department of Pathology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg, France.
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Averous
authors.affiliation: IRCAD-EITS, University Hospital of Strasbourg, 1 Place de l'Hôpital 1, 67091, Strasbourg, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Dallemagne
authors.affiliation: IRCAD-EITS, University Hospital of Strasbourg, 1 Place de l'Hôpital 1, 67091, Strasbourg, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000556:secondary; D000818:Animals; D004311:Double-Blind Method; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D018613:Microscopy, Confocal; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011897:Random Allocation; D051381:Rats; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Confocal microscopy; Lymph nodes; Pancreatic cancer; Rat model; Staging