A study on confocal endomicroscopy in comparison with histopathology for polypoidal lesions of the gastrointestinal tract: A prospective single-centre experience.

Abstract

Confocal laser endomicroscopy (CLE) has a potential to make optical diagnosis of neoplastic polypoidal lesions and may replace traditional histology in the proposed "diagnose and discard approach". Thepresent study was planned to assess the accuracy of probe-based CLE in predicting histology of polypoidal lesions of gastrointestinal (GI) tract in vivo before their removal. In this prospective single-centre study, patients with upper and/or lower GI polypoidal lesions were enrolled. After detection of polypoidal lesions with white light endoscopy, probe-based CLE examination was performed. Real-time and offline presumptive CLE diagnosis of polypoidal lesions was made as per Miami classification and was compared with histopathology as the gold standard. A total of 50 GI polyps from 50 patients (28 males) were assessed. The mean (±SD) size of polyps was 13.7 (± 8.5) mm. Most polyps were located at the cecum (24.0%) or stomach (24.0%). On histological examination, hyperplastic andadenomatous polyps, adenocarcinoma, and lipoma were seen in 54%, 26%, 18% and 2% patients, respectively. On comparison of real-time CLE examination with histopathology, 40 (83.3%) and 8 patients (16.7%) had concordant anddiscordant results, respectively. Two polyps were inconclusively diagnosed on CLE. On offline examination, concordance with histopathology was observed in 85.4% (n = 41) of polyps, which was marginally better than online examination, though the difference was not statistically significant (p = 0.45). On comparing the real-time and offline findings of CLE, concordance was found in 91.7% of the cases. Accuracy, sensitivity, specificity, positive and negative predictive values on real-time evaluation were 83.3%, 87.5%, 79.1%, 80.7%, and 86.3%, respectively. CLE is a useful tool for prediction of histology to assess the polypoidal lesions of the GI tract, and it may avoid polypectomy at least in some patients.