Abstract
Objective To evaluate the performance of probe-based confocal laser endomicroscopy (pCLE) in diagnosis of gastric lesions. Methods An outpatient department- (OPD-) based retrospective study was conducted for patients with suspected upper gastrointestinal (GI) tract lesions who underwent pCLE between 2014 and 2016 at a tertiary hospital in China. Final diagnosis was based on the histopathological reports. CLE reports were compared to histopathological reports to evaluate the diagnostic ability, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Results 322 of 380 patients were diagnosed with gastric lesions via pCLE, including inflammation and benign ulcers (n = 110), atrophy and intestinal metaplasia (n = 152), intraepithelial neoplasia (n = 27), adenocarcinoma (n = 27), and lymphoma (n = 6). In total, the diagnostic ability of CLE in evaluation of gastric lesions showed sensitivity 72.4% (95% confidence interval (CI): 67.1–77.2%); specificity 93.1% (95% CI: 5.6–8.4%); PPV 72.4% (95% CI: 67.1–77.2%); NPV 93.1% (95% CI: 5.6–8.4%); and accuracy 88.9% (95% CI: 87.3–90.4%), respectively. We further observed the capability of pCLE in diagnosing six gastric lymphoma showing those affected mucosa densely infiltrated with identical and round-shaped abnormal cells. Immunohistochemistry analysis confirmed one patient with diffuse large B-cell non-Hodgkin's lymphoma (DLBCL) and five with mucosa-associated lymphoid tissue (MALT) lymphoma. Conclusion pCLE is an accurate tool for the detection of gastric lesions and shows optimal values of sensitivity and negative predictivity. Moreover, combining pCLE with white light endoscopy (WLE) may be a promising adjunct to conventional biopsy sampling in evaluating GI tract with suspected lymphoma.
Highlights
CLE technology is an emerging technology and enables endoscopists to collect real-time in vivo histological images or “virtual biopsies” of the gastrointestinal (GI) mucosa at high resolution [1]
Between October 13, 2014, and December 30, 2016, a total of 327 gastric lesions from 327 patients using white light endoscopy (WLE) and probe-based confocal laser endomicroscopy (pCLE) procedures were retrospectively assessed at outpatient department- (OPD-)based endoscopy unit in Huazhong University of Science and Technology (HUST)
The present study retrospectively evaluated patients who have been performed pCLE procedures based on a singlecenter experience
Summary
CLE technology is an emerging technology and enables endoscopists to collect real-time in vivo histological images or “virtual biopsies” of the gastrointestinal (GI) mucosa at high resolution [1]. The potential role of CLE in revealing premalignant and malignant lesions has been of extreme relevance to different pathologic conditions. Many studies demonstrate a high correlation between CLE and histopathology results with accuracy ranging from 86% to 96% [3]. Two CLE-based systems are used in routine clinical practice and research. One is an endoscope-integrated CLE (eCLE) system that collects images at a manually adjustable scan rate of 1.6 frames per second. The optical slices of this specialized endoscope are parallel with the mucosal surface with a lateral resolution of 0.7 μm, and the scanning depth
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