Recent Advances and the Potential for Clinical Use of Autofluorescence Detection of Extra-Ophthalmic Tissues

The autofluorescence (AF) characteristics of endogenous fluorophores allow the label-free assessment and visualization of cells and tissues of the human body. While AF imaging (AFI) is well-established in ophthalmology, its clinical applications are steadily expanding to other disciplines. This review summarizes clinical advances of AF techniques published during the past decade. A systematic search of the MEDLINE database and Cochrane Library databases was performed to identify clinical AF studies in extra-ophthalmic tissues. In total, 1097 articles were identified, of which 113 from internal medicine, surgery, oral medicine, and dermatology were reviewed. While comparable technological standards exist in diabetology and cardiology, in all other disciplines, comparability between studies is limited due to the number of differing AF techniques and non-standardized imaging and data analysis. Clear evidence was found for skin AF as a surrogate for blood glucose homeostasis or cardiovascular risk grading. In thyroid surgery, foremost, less experienced surgeons may benefit from the AF-guided intraoperative separation of parathyroid from thyroid tissue. There is a growing interest in AF techniques in clinical disciplines, and promising advances have been made during the past decade. However, further research and development are mandatory to overcome the existing limitations and to maximize the clinical benefits

Updated management of malignant biliary tract tumors: an illustrative review

The management of malignant biliary tumors (MBTs) is complex and requires a multidisciplinary approach. Guidelines and methods of staging for biliary tumors have recently been released by main international societies, altering the clinical and radiologic approach to this pathologic condition. The aim of the present review is to detail the updated role of imaging in preoperative staging and follow-up and to illustrate clinical/therapeutic pathways. In addition, future perspectives on imaging and targeted/embolization therapies are outlined

What should be known prior to performing EUS exams? (Part II)

In "What should be known prior to performing EUS exams, Part I," the authors discussed the need for clinical information and whether other imaging modalities are required before embarking EUS examinations. Herewith, we present part II which addresses some (technical) controversies how EUS is performed and discuss from different points of view providing the relevant evidence as available. (1) Does equipment design influence the complication rate? (2) Should we have a standardized screen orientation? (3) Radial EUS versus longitudinal (linear) EUS. (4) Should we search for incidental findings using EUS

EUS-B-FNA for Diagnosing Liver and Celiac Metastases in Lung Cancer Patients

Background: In patients with suspected or proven lung cancer, assessment of regional nodal and distant metastases is key before treatment planning. By introducing the endobronchial ultrasound (EBUS)-guided scope into the esophagus and stomach (EUS-B), liver lesions and celiac nodes can be visualized. To date, the utility of EUS-B in diagnosing liver lesions and retroperitoneal lymph nodes is unknown. Objectives: To assess the feasibility, safety, and diagnostic yield of sampling of liver lesions and retroperitoneal nodes by EUS-B fine-needle aspiration (FNA) in a lung cancer staging setting. Method: Consecutive patients suspected of lung cancer in 2 Danish centers between 1 January 2015 and 31 December 2017 were included retrospectively when a lesion in the liver or a retroperitoneal lymph node was visualized and biopsied with EUS-B-FNA. Results: 23 left liver lobe lesions and 19 retroperitoneal lymph nodes were sampled by EUS-B-FNA. Sensitivity and diagnostic yield of sampled liver lesions were 86 and 83%, respectively. In 19/23 patients, there was a cytopathological diagnosis of malignancy. Sensitivity and diagnostic yield from retroperitoneal lymph node samples were 83 and 63%, respectively. In 10/19 patients, the diagnosis was malignancy. No complications were observed. Conclusion: EUS-B-FNA enables safe sampling of left liver lobe lesions and retroperitoneal lymph nodes. EUS-B should be considered as a minimally invasive technique to provide tissue proof of distant metastases lung cancer patients

Advanced Endoscopic Navigation:Surgical Big Data,Methodology,and Applications

随着科学技术的飞速发展，健康与环境问题日益成为人类面临的最重大问题之一。信息科学、计算机技术、电子工程与生物医学工程等学科的综合应用交叉前沿课题，研究现代工程技术方法，探索肿瘤癌症等疾病早期诊断、治疗和康复手段。本论文综述了计算机辅助微创外科手术导航、多模态医疗大数据、方法论及其临床应用：从引入微创外科手术导航概念出发，介绍了医疗大数据的术前与术中多模态医学成像方法、阐述了先进微创外科手术导航的核心流程包括计算解剖模型、术中实时导航方案、三维可视化方法及交互式软件技术，归纳了各类微创外科手术方法的临床应用。同时，重点讨论了全球各种手术导航技术在临床应用中的优缺点，分析了目前手术导航领域内的最新技术方法。在此基础上，提出了微创外科手术方法正向数字化、个性化、精准化、诊疗一体化、机器人化以及高度智能化的发展趋势。【Abstract】Interventional endoscopy (e.g., bronchoscopy, colonoscopy, laparoscopy, cystoscopy) is a widely performed procedure that involves either diagnosis of suspicious lesions or guidance for minimally invasive surgery in a variety of organs within the body cavity. Endoscopy may also be used to guide the introduction of certain items (e.g., stents) into the body. Endoscopic navigation systems seek to integrate big data with multimodal information (e.g., computed tomography, magnetic resonance images, endoscopic video sequences, ultrasound images, external trackers) relative to the patient's anatomy, control the movement of medical endoscopes and surgical tools, and guide the surgeon's actions during endoscopic interventions. Nevertheless, it remains challenging to realize the next generation of context-aware navigated endoscopy. This review presents a broad survey of various aspects of endoscopic navigation, particularly with respect to the development of endoscopic navigation techniques. First, we investigate big data with multimodal information involved in endoscopic navigation. Next, we focus on numerous methodologies used for endoscopic navigation. We then review different endoscopic procedures in clinical applications. Finally, we discuss novel techniques and promising directions for the development of endoscopic navigation.X.L. acknowledges funding from the Fundamental Research Funds for the Central Universities. T.M.P. acknowledges funding from the Canadian Foundation for Innovation, the Canadian Institutes for Health Research, the National Sciences and Engineering Research Council of Canada, and a grant from Intuitive Surgical Inc

Trans-esophageal endobronchial ultrasound-guided needle aspiration (EUS-B-NA) : a road map for the chest physician

The endobronchial ultrasound (EBUS) scope has been increasingly used in the gastrointestinal tract (EUS-B). Scientific data proves its efficacy and safety to provide a complete lung cancer staging, when combined with EBUS-TBNA, and in the diagnosis of para-esophageal lesions. There are multiple barriers to start performing EUS-B but probably the most important ones are related to knowledge and training, so new operators should follow a structured training curriculum. This review aims to reflect the best current knowledge regarding EUS-B and provide a road map to assist those who are incorporating the technique into their clinical practice

Unveiling mediastinal pathology: role of EUS guided fine needle aspiration in diagnosing mediastinal lesions

Background: Mediastinal lesion is the focus of investigation in diagnosis of infective, granulomatous or neoplastic pathology of respiratory system. Metastatic mediastinal node assessment is an integral part of oncological management. EUS provides access to sampling of mediastinal mass, sub-carinal and aorto-pulmonary nodes. This study aims to assess the clinical impact, diagnostic yield and safety of EUS guided FNA for mediastinal lesions.Methods: Retrospective analysis of prospectively collected data of 72 cases of mediastinal lesions between January 2014 and December 2017 was done. EUS-FNA was performed with a linear echoendoscope using a 22- or 25-gauge needle. Adequacy of cellularity was assessed by on site pathologist. Patient data (demographics, intervention and follow-up) were prospectively collected and introduced in a predefined computer database for later review.Results: EUS-FNA was performed from 57 lymph nodes and 15 mediastinal masses. Adequate samples were obtained in 67 of 72 patients (93.05%). All mediastinal masses were malignant and were identified in the 3rd, 5th and 6th decade of life. Of the 57 lymph nodes, 15 were malignant, 28 had granulomatous lymphadenitis of which 16 individuals became asymptomatic after anti tubercular therapy. Sample was inadequate in 5 circumstances. No major complications were encountered with the procedure in any of the individuals.Conclusions: EUS guided tissue diagnosis is a safe technique and our data supports the use of EUS-FNA in work-up of mediastinal lesions. It is minimally invasive, accurate and has easy access to mediastinum. It has significant impact on patient diagnosis, management and should be considered over other invasive techniques

Endoscopic bronchial ultrasound in mediastinal staging of lung cancer

Lung cancer is a global healthcare concern with a low 5-year survival rate and a high proportion of advanced-stage cases at diagnosis. In the absence of distant metastasis, the most important prognostic marker is mediastinal lymph node involvement. Timely diagnosis and staging improves prognosis, making rapid, safe, and accurate investigation essential. Endoscopic bronchial ultrasound (EBUS) is a minimally invasive technique which allows for ultrasound-guided transbronchial needle aspiration (TBNA) during bronchoscopy, with cytological sampling of several intrathoracic groups of lymph nodes. EBUS reduces need for open surgical biopsy, with good sensitivity and specificity and excellent safety profile. This article reviews current evidence regarding use of EBUS in lung cancer staging, including its role in other intrathoracic malignancies.eviews current evidence regarding use of EBUS in lung cancer staging, including its role in other intrathoracic malignancies.peer-reviewe