Confocal Laser Endomicroscopy In Diagnosis Research Articles

Confocal Laser Endomicroscopy Can Improve the Diagnosis Rate and Range Assessment of Patients With Conflicting Chronic Atrophic Gastritis Results of White Light Endoscopic and Pathological Diagnosis.

Background and AimsChronic atrophic gastritis (CAG) is closely related to the development of gastric cancer. However, the diagnostic accuracy of white light endoscopy (WLE) biopsy for CAG is poor. The diagnostic role and efficacy of confocal laser endomicroscopy (CLE) in CAG missed under WLE biopsy remain unclear.MethodsThis study is a single-center prospective study that included 21 patients from 1,349 patients who underwent WLE and biopsy and whose WLE results confirmed CAG, but pathological results did not. Then, all these patients received CLE examination and underwent targeted biopsies and five-point standard biopsies. The sensitivity, specificity, and accuracy of CLE diagnosis and targeted biopsy were analyzed.ResultsThe pathological results of five-point standard biopsies in 21 patients confirmed CAG, and 17 patients (81.0%) were confirmed to have intestinal metaplasia (IM). According to the image diagnosis of CLE, there were 19 cases (90.5%) of CAG and 14 cases (66.7%) of IM among these 21 patients. According to the targeted biopsy of CLE, 17 cases (81.0%) of CAG and 14 cases (66.7%) of IM were diagnosed. There was no significant difference between CLE image diagnosis and five-point standard biopsies in terms of atrophy severity score (p = 0.927), IM severity score (p = 0.250), atrophy scope score (p = 0.781), and IM scope score (p = 0.195). For CAG, the sensitivity and accuracy of CLE image diagnosis were higher than those of CLE targeted biopsies (90.5% vs. 81.0%, p = 0.331), but for IM, the diagnosis was the same.ConclusionsCLE can improve the diagnosis rate of CAG and can increase the comprehensive assessment of the scope and severity of CAG.

Value of endoscopy with narrow-band imaging and probe-based confocal laser endomicroscopy in the diagnosis of preneoplastic lesions of gastrointestinal tract.

Introduction: Amongst all malignant tumors, cancers of the digestive tract rank first in terms of yearly deaths. Patients above 60 years of age are the most affected, as the diagnosis is frequently made in advanced stages of the disease when therapy is less effective. Our study aimed to evaluate the efficiency of narrow-band imaging (NBI) endoscopy and probe-based confocal laser endomicroscopy (pCLE) in the correct diagnosis of preneoplastic lesions in the upper and lower digestive tract. Patients, Materials and Methods: We included 46 patients with digestive preneoplastic lesions, who underwent either upper or lower digestive endoscopy, followed by NBI and pCLE. We recorded 5–10 frames per each lesion, from different angles and distances during white-light endoscopy and selected frames from full recordings of NBI and pCLE. Usual preparation was used for the endoscopic procedures; pCLE required in vivo administration of 10% Sodium Fluorescein as a contrast agent. Pathology was performed in case of solid tumors. Three medical professionals with different levels of training, blinded to the results, interpreted the data. Results: The experienced physician correlated very well the NBI findings with pathology (0.93, p=0.05), while the resident physician and the experienced nurse obtain lower, albeit still statistically significant, values (0.73 and 0.62, respectively). For pCLE, the experienced physician obtained near-perfect correlation with pathology (0.96), followed closely by the resident physician (0.93). The nurse obtained a modest correlation (0.42). All examiners obtained approximately equal performances in discerning between malignant and benign lesions. Conclusions: Digestive endoscopy in NBI mode proved its effectiveness. Even less experienced endoscopists can achieve good results, while an experienced nurse can positively influence the diagnosis. In the case of pCLE, when available, it can greatly reduce diagnostic times, while requiring higher expertise and specialty training.

S0130 Efficacy of Endoscopic-Guided Needle-Based Confocal Laser Endomicroscopy in Diagnosis of Pancreatic Lesions: A Systematic Review and Meta-Analysis

S0130 Efficacy of Endoscopic-Guided Needle-Based Confocal Laser Endomicroscopy in Diagnosis of Pancreatic Lesions: A Systematic Review and Meta-Analysis

Confocal laser endomicroscopy of the upper digestive tract: history of development and screening

Confocal laser endomicroscopy is an endoscopic diagnostic technique developed for real-time histological diagnosis of gastrointestinal diseases. This review is devoted to analysis of confocal laser endomicroscopy in diagnosis of gastrointestinal diseases, especially for screening or monitoring of gastrointestinal neoplasia.

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

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.

Application of probe-based confocal laser endomicroscopy in diagnosis of gastric carcinoma and precancerous lesions

To assess the application of probe-based confocal laser endomicroscopy (pCLE) in diagnosis of gastric carcinoma and precancerous lesions. Patients underwent pCLE in the First Affiliated Hospital of Zhejiang University School of Medicine during December 2013 and November 2014 and in the First Affiliated Hospital of Zhejiang Chinese Medical University during January 2014 and December 2017 were enrolled. The consistency between pCLE diagnosis and pathological diagnosis of gastric lesions, including atrophic gastritis, gastric intestinal metaplasia, low-grade intraepithelial neoplasia and high-grade intraepithelial neoplasia (including gastric carcinoma) was analyzed. Totally 154 gastric lesions from 119 patients were detected by pCLE. Using pathological diagnosis as gold standard, the sensitivity, specificity, coincidence rate and κ value of pCLE diagnosis for atrophic gastritis were 94.34%, 91.09%, 92.21%and 0.83; those indicators for gastric intestinal metaplasia were 84.47%, 92.16%, 87.01% and 0.72. The coincidence rate and κ value of pCLE diagnosis of complete gastric intestinal metaplasia were 0.75 and 0.49; for incomplete gastric intestinal metaplasia were 0.79 and 0.48, respectively. The sensitivity, specificity, coincidence rate and κ value of pCLE diagnosis for low-grade intraepithelial neoplasia were 85.29%, 87.50%, 87.01%and 0.66; those for high-grade intraepithelial neoplasia (including gastric carcinoma) were 95.83%, 97.17%, 96.75%and 0.92. pCLE can be used for diagnosis of gastric carcinoma and pericancerous lesions and also for typing of gastric intestinal metaplasia.

Video Comment on Ming-Ming Zhang et al.

Ming-Ming Zhang et al. Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of gastric subepithelial tumors: a pilot study

Confocal laser endomicroscopy in diagnosis of extrahepatic biliary strictures

Confocal laser endomicroscopy in diagnosis of extrahepatic biliary strictures

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of solid pancreatic lesions

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of solid pancreatic lesions

Novel insights into esophageal diagnostic procedures.

The 21st century offers new advances in diagnostic procedures and protocols in the management of esophageal diseases. This review highlights the most recent advances in esophageal diagnostic technologies, including clinical applications of novel endoscopic devices, such as ultrathin endoscopy and confocal laser endomicroscopy for diagnosis and management of Barrett's esophagus; novel parameters and protocols in high-resolution esophageal manometry for the identification and better classification of motility abnormalities; innovative connections between esophageal motility disorder diagnosis and detection of gastroesophageal reflux disease (GERD); impedance-pH testing for detecting the various GERD phenotypes; performance of distensibility testing for better pathophysiological knowledge of the esophagus and other gastrointestinal abnormalities; and a modern view of positron emission tomography scanning in metastatic disease detection in the era of accountability as a model for examining other new technologies. We now have better tools than ever for the detection of esophageal diseases and disorders, and emerging data are helping to define how well these tools change management and provide value to clinicians. This review features novel insights from multidisciplinary perspectives, including both surgical and medical perspectives, into these new tools, and it offers guidance on the use of novel technologies in clinical practice and future directions for research.

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of solid pancreatic lesions (ENES): a pilot study.

Background and study aims: Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy (EUS-nCLE) has been shown to aid in the diagnosis of cystic pancreatic lesions. This is a pilot project to study its findings in patients with solid pancreatic lesions (SPLs) with a prospective single-blinded study design. Methods: Patients with SPLs undergoing trans-gastric EUS fine needle aspiration (EUS-FNA) from July 2013 to March 2014 were prospectively enrolled. The nCLE diagnoses were compared with the final diagnoses. Researchers learned about the EUS-nCLE findings from previously published studies and applied it to diagnose SPLs. In the meantime, the findings were recorded. Results: In total, 22 patients were recruited (mean age 62.7 years, SD 13.8 years; 14 men and eight women). The mean maximal tumor diameter was 36.0 mm (SD 10.9 mm). EUS-nCLE yielded satisfactory images in all patients during the first EUS procedure and diagnosed benign and malignant SPLs in 3 and 19 patients, respectively. Final diagnoses of malignant SPLs were made in 19 patients. Benign SPLs were eventually diagnosed in three patients, with confirmed the cytology and disease stability during the 12-month follow-up period. At the end of the project, based on the results of this current study, EUS-nCLE findings for malignant SPLs were dark clumping with or without dilated vessels (> 40 μm). There were two criteria for diagnosing benign lesions which were white fibrous bands and normal acini cells. The accuracy rate of EUS-nCLE was 90.9 % (20/22). One falsely diagnosed malignant SPL was an inflammatory mass from a recent acute pancreatitis. Another one with a pancreatic neuroendocrine tumor presenting with a symptomatic pseudocyst was incorrectly diagnosed as an inflammatory mass. This was likely from sampling error of the EUS-nCLE probe in an inflammatory area. Only one patient had post EUS-FNA bleeding but did not require a blood transfusion. The inter-observer agreement among three blinded endoscopists was almost perfect (Kappa 0.82). Conclusion: EUS-nCLE is a promising technique for the diagnosis of SPLs with good inter-observer agreement.Study registration‎: TCTR20140402001

PO-116: Confocal laser endomicroscopy in diagnosis and treatment of ENT lesions: a feasibility study, preliminary results

PO-116: Confocal laser endomicroscopy in diagnosis and treatment of ENT lesions: a feasibility study, preliminary results

A role of probe-based confocal laser endomicroscopy for diagnosis of pulmonary alveolar proteinosis

Introduction. Probe-based confocal laser endomicroscopy (pCLE) of distal airways is a new technology allowing visualization of cells and structures that have autofluorescence. Endomicroscopic features of a number of rare lung diseases including pulmonary alveolar proteinosis (PAP) has not been yet investigated. The purpose of the study was to describe endomicroscopic features of PAP before and after the whole lung lavage (WLL). Methods. pCLE was performed during bronchoscopy in 6 PAP patients before and after the WLL. In certain lung segments, pCLE was done under the HRCT control. More than 1300 endomicroscopic images have been evaluated using a semiquantitative method. Results. We found floating fluorescent amorphous aggregates sticking with alveolar macrophages in all the patients. These changes reduced after the WLL. pCLE allowed to reveal PAP characteristic features not only in lung segments with «crazy paving» HRCT sign but also in lung zones without any HRCT changes. Conclusions. pCLE can detect specific PAP features both at presence and absence of HRCT signs that confirms diffuse injury of the lung parenchyma. pCLE could be a helpful tool for diagnosis and assessment of treatment efficacy in patients with PAP.

High Resolution White Endoscopy with Chromoendoscopy and Confocal Laser Endomicroscopy for Atrophic Gastritis Surveillance: One Center Experience

Purpose: Atrophic gastritis (AG) is a well-characterized premalignant condition with a significantly increased risk for developing gastric neoplasia. A rigorous upper endoscopy surveillance program has been shown to undoubtedly reduce this risk. However, white light endoscopy random multiple biopsies in the regular standard of care missed lesions of high grade dysplasia and neoplasia in atrophic gastritis with commonly in patchy distribution. Recently, multiple new endoscopic imaging technologies such as chromoendoscopy with indigo carmine, which, with increased sensitivity, are able to obtain, and confocal laser endomicroscopy (CLE), which is developed to provide a more detailed visualization of the mucosa by enhancing morphology and vascularization with high specificity. Methods: In this prospective clinical trial, 20 patients from the First Hospital of Jilin University undergoing endoscopic screening and surveillance for AG were enrolled. High-definition white light endoscopy followed by indigo carmine sprayed in the antrum was performed to search for highly interested spot of lesions in antrum, followed by the CLE scan performed by two endoscopists experienced more than 30 CLE examinations and biopsy for standard histological pathologic diagnosis as “ gold standard”, and sent to a single GI pathologist to provide diagnosis. The endoscopists CLE diagnosis and standard pathologic diagnosis were compared. Results: The comparison of CLE plus chromoendoscopy to histological pathology diagnosis is sensitivity 89.00%, and specificity 87.50% in atrophic gastritis (Kappa=0.0495, 0.4<k<0.75), sensitivity 97.98%, specificity 94.59% (Kappa=0.557, 0.4<k<0.75). Conclusion: CLE has significant consistency to the pathology diagnosis in the atrophic gastritis and intestinal metaplasia. CLE with chromoendoscopy enhances the diagnostic accuracy, clinical real-time result and decision. CLE with chromoendoscopy has potential advantage for diagnosis and treatment of atrophic gastritis.

Confocal Laser Endomicroscopy for Diagnosis and Histomorphologic Imaging of Brain Tumors In Vivo

Early detection and evaluation of brain tumors during surgery is crucial for accurate resection. Currently cryosections during surgery are regularly performed. Confocal laser endomicroscopy (CLE) is a novel technique permitting in vivo histologic imaging with miniaturized endoscopic probes at excellent resolution. Aim of the current study was to evaluate CLE for in vivo diagnosis in different types and models of intracranial neoplasia. In vivo histomorphology of healthy brains and two different C6 glioma cell line allografts was evaluated in rats. One cell line expressed EYFP, the other cell line was used for staining with fluorescent dyes (fluorescein, acriflavine, FITC-dextran and Indocyanine green). To evaluate future application in patients, fresh surgical resection specimen of human intracranial tumors (n = 15) were examined (glioblastoma multiforme, meningioma, craniopharyngioma, acoustic neurinoma, brain metastasis, medulloblastoma, epidermoid tumor). Healthy brain tissue adjacent to the samples served as control. CLE yielded high-quality histomorphology of normal brain tissue and tumors. Different fluorescent agents revealed distinct aspects of tissue and cell structure (nuclear pattern, axonal pathways, hemorrhages). CLE discrimination of neoplastic from healthy brain tissue was easy to perform based on tissue and cellular architecture and resemblance with histopathology was excellent. Confocal laser endomicroscopy allows immediate in vivo imaging of normal and neoplastic brain tissue at high resolution. The technology might be transferred to scientific and clinical application in neurosurgery and neuropathology. It may become helpful to screen for tumor free margins and to improve the surgical resection of malignant brain tumors, and opens the door to in vivo molecular imaging of tumors and other neurologic disorders.

Comparison between confocal laser endomicroscopy and gastric biopsy for diagnosis of early gastric cancer and precancerous disease

Objective To compare the diagnositie values of confocal laser endomicroscopy （CLE） and gastric biopsy. Methods A total of 46 patients with suspicious early gastric cancer diagnosed by eonv-ential gastroscopy underwent CLE. Fluorescein sodium was intravenously injected, and suspicious lesions were observed and CLE pictures were saved. Random biopsy specimen was taken from the suspicious lesions for histopathological examination and the result of CLE and gastric biopsy was compared according to final histopathologieal finding. Kappa test was used to determine the consistency, and the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accurate rate were then calculated. Results Of the 46 patients with suspicious early gastric cancer, 36 patients underwent endoscopic submueo-sal dissection （ESD） and other 10 patients underwent surgery. The Kappa value of CIE and post-ESD and surgery histopothological examination was 0. 720. The Kappa value of gastric biopsy and post-ESD and surgery histopothologieal examination was 0. 437. The sensitivity, specificity, the positive predictive value, the neg-ative predictive value and the diagnostic accurate value of CLE in diagnosis of gastric neoplasia were 97.6% , 80. 0%, 97.6% , 80. 0% and 95.7%. Conclusion CLE is significant value for diagnosis of early gastric cancer and precancerous disease with a high consistency with histopathology. Key words: Stomach neoplasms ; Biopsy; Confocal laser endomicroscopy; Diagnositic

Optical biopsies by confocal endomicroscopy prevent additive endoscopic biopsies before endoscopic submucosal dissection in gastric epithelial neoplasias: a prospective, comparative study

Confocal laser endomicroscopy (CLE) allows real-time in vivo histologic evaluation of GI lesions. To our knowledge, there is no reported prospective study comparing endoscopic and optical biopsy using CLE before endoscopic submucosal dissection (ESD) with post-ESD histopathology. We compared endoscopic and optical biopsy before ESD and thereby assessed the ability of CLE to effectively diagnose and differentiate gastric epithelial neoplasia. Single tertiary-care center, prospective comparative study. Soonchunhyang University Hospital, between September 2009 and April 2010. This study involved 31 patients with 35 gastric epithelial neoplasias, previously diagnosed by endoscopic biopsy, who were scheduled for ESD. Target lesions were imaged in vivo by using CLE. The overall accuracy of endoscopic and CLE diagnosis was compared with post-ESD histopathology. In histopathology after ESD, 11 of 35 lesions (31.5%) were adenomas and 24 (68.5%) were adenocarcinomas. The overall accuracy of CLE diagnosis of gastric adenomas and adenocarcinomas was significantly higher at 94.2% (95% confidence interval [CI], 81.3-98.4), versus 85.7% (95% CI, 70.6-93.7) for endoscopic biopsy (P = .031). The overall accuracy of CLE diagnosis of differentiated and undifferentiated adenocarcinomas also was higher (95.4%; 95% CI, 78.2-99.1) than that of endoscopic biopsy (84.2%; 95% CI, 62.4-94.4) but did not differ significantly (P = .146). Single tertiary-care center experience and small patient number. This study demonstrates the high accuracy of diagnosis of gastric epithelial neoplasia by using CLE. The use of CLE could possibly thus reduce the number of unnecessary biopsies and mistaken diagnoses before ESD.

Prospective evaluation of the learning curve of confocal laser endomicroscopy in patients with IBD.

Confocal laser endomicroscopy (CLE) represents a novel endoscopic imaging technique which enables the in vivo microscopic imaging within the mucosal layer of the gut at subcellular resolution. Currently, there are no data available on the learning curve of CLE, which was therefore the aim of our study. Twenty-six consecutive patients with inflammatory bowel disease (IBD) underwent total colonoscopy and were examined by fluorescein-aided CLE. Image data were collected and reviewed by two endoscopists in a blinded fashion. CLE images were compared to endoscopical and histological findings. Prospectively, the following performance parameters were documented: total duration of the procedure, confocal imaging time, time to receive a confocal image in focus, number of confocal images, number of confocal images in focus, CLE diagnosis and final histopathological diagnosis. A significance decrease of CLE duration was detected between the first 8 and the subsequent cases (p=0.002). Confocal imaging time and the time to receive an image in focus declined significantly over time (p=0.0001), while number of images in focus significantly increased (p=0.0007). Agreement between CLE and histopathology improved over time with kappa values of 0.81 after twenty-six cases. There was a significant improvement in CLE performance over time, including decreased confocal imaging time, successful CLE diagnosis and decline in procedural time. These parameters improved significantly after the initial three cases. Therefore, CLE represents an easy to learn and apply novel diagnostic method for in vivo analysis and diagnosis in IBD.

Diagnostic value of confocal laser endomicroscopy for gastric superficial cancerous lesions

BackgroundThe identification of gastric superficial cancerous lesions based on conventional white-light endoscopy (WLE) is challenging, and histological analysis remains the ‘gold standard’ for the final diagnosis. Confocal laser endomicroscopy (CLE)...

Confocal endomicroscopy for in vivo prediction of completeness after endoscopic mucosal resection

Endoscopic mucosal resection (EMR) is an alternative to surgery for removal of superficial gastric neoplastic lesions. Residual neoplastic tissue of the resection interface is difficult to detect by conventional endoscopy. The aim of this study is to assess the efficacy of confocal laser endomicroscopy (CLE) in predicting complete resection margins after EMR. EMR was performed by using cap-assisted or "inject and cut" resection technique. Two weeks after EMR, the circumferential margins of the defect were inspected by using CLE, and completeness of excision was predicted from the CLE image. Additional EMR was performed if necessary. In vivo CLE diagnosis was validated against final histopathology. Twenty-seven lesions were removed by EMR in 27 patients. After excluding 3 patients for gastrectomy, a total of 24 patients underwent CLE assessment, of whom 9 with indefinite lateral margins underwent at least two consecutive CLE follow-ups. A total of 19 lesions were regarded as complete remission, and 5 lesions (21.7%) were incompletely excised according to final pathologic diagnosis. Accuracy of CLE in predicting incomplete resection for original lesions was 91.7%, with sensitivity and specificity of 100.0 and 89.5%, respectively. The residual lesions were treated by additional EMR guided by CLE. There was no recurrence on endoscopic biopsies at mean (range) follow-up of 8.3 (4-15) months. Confocal laser endomicroscopy has high accuracy for prediction of remnant tissue after EMR, and may lead to significant improvements in clinical surveillance after endoscopic resection.