Abstract 5978: Real time pathologic diagnosis of digital biopsy during lung cancer surgery using confocal laser endomicroscopy

Purpose: Portable hand held confocal laser endomicroscopy is a novel, noninvasive technology that provides real time imaging during biopsy procedure and could be used to perform rapid histopathological diagnosis. However, its ability of determining whether the ex vivo samples obtained during lung cancer surgery or biopsy are tumor or non tumor is yet to be evaluated. Methods: Real time imaging of 75 surgical samples was performed. In preanalytic process, the samples were stained with fluorescent dye. Benign and malignant histologic structures were classified by cell density, nuclear size variability, and nuclear arrangement, which are compared with HE images from the same section. Results: We defined the confocal laser endomicroscopy atypia classification from the findings of the cells and made a comprehensive atlas of digital biopsy images for pleural surface, bronchus, and lung parenchyma. A total of 3,734 digital images were correlated with 75 frozen lung specimens. Three pathologists assessed digital biopsy images for defining cancer versus non cancer. Overall accuracy was 92.2%, The sensitivity for malignancy was 100% and the specificity was 84.4%. Both inter observer (k = 0.51) and intra observer (k = 0.52) agreement confirmed moderate agreement. Conclusion: Portable confocal laser endomicroscopy was useful to differentiate malignant from benign, to assess the histology of pleural surface and bronchial margin and might be substitute for rapid on site evaluation of pathologic diagnosis during surgical or biopsy procedure. Citation Format: Tae-Jung Kim, Young Jo Sa, Sung Ah Kim, Kyungmin Hwang. Real time pathologic diagnosis of digital biopsy during lung cancer surgery using confocal laser endomicroscopy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5978.