Can Endo-Cytoscope System (ECS) Predict Histology in Neoplastic Lesions?

Abstract

An endocytoscope system (ECS) with a super-high-magnification probe has recently been developed. This system allows imaging of living cells from in vivo gastrointestinal mucosa. Aim of the study was to assess its potential for prediction of histology in normal gastrointestional mucosa and neoplastic lesions. Methods: 73 patients (57M/16W; 37-86 yrs) with neoplastic lesions in esophagus, stomach and colon were enrolled into the study and underwent esophagogastroscopy or colonoscopy. Methylene blue 1% solution was applied through a spraying catheter on the lesion and normal mucosa. Then two ECS probes with 450× and 1100× magnification were successively passed through the channel of the endoscope working with a gentle contact to tissue surface. The magnified image was continuously observed for several minutes and recorded on CD. Afterwards biopsies were taken from normal mucosa and neoplastic lesion at the sites of the ECS-examination. Biopsies and sequences of magnified images, recorded on CD, were evaluated by two pathologists in a blinded fashion and separately by the endoscopist. The pathologist evaluating recorded sequences of ECS was informed only about the site of examination (e.g. esophagus). Results: 24 pts with esophageal lesions (SCC: n = 12, adenocarcinoma: n = 6, barrett's esophagus: n = 5, peptic stenosis: n = 1), 26 pts with colonic lesions (colorectal cancer: n = 11, colorectal adenomas: n = 14, CU: n = 1) and 23 pts with gastric lesions (adenocarcinoma n = 19, GIST n = 1, benign ulcer: n = 3) were examined. The results for ecs-findings using two magnification probes (450× and 1100×) in esophagus, stomach and colon in comparison with histology as gold standard are described in table 1. The combination of macroscopic and cytoscopic view by the endoscopist resulted in a higher sensitivity. Conclusions: First experiences with ECS show a sensitivity up to 91% for pathologic findings in esophagus and colon by a single pathologist without experience in this method. Sensitivity of neoplastic lesions in stomach is lower because of gastric mucous secretion. Combining the endoscopic and cytoscopic appearance of the lesion enhances the diagnostic value of the method. Table 1 (Pathologist) Sensitivity Specifity +pv −pv Esophagus 450× 1100× 77% 91% 100% 100% 100% 100% 81% 92% Stomach 450× 1100× 33% 75% 95% 83% 86% 79% 62% 79% Colon 450× 1100× 61% 83% 86% 87% 79% 83% 73% 87% (Endoscopist) Sensitivity Specifity +pv −pv macro- and microscopy 96% 95% 98% 91% Open table in a new tab