Comparative diagnostic performance of volumetric laser endomicroscopy and confocal laser endomicroscopy in the detection of dysplasia associated with Barrett’s esophagus

Abstract

Background and Aims Probe-based confocal laser endomicroscopy (pCLE) and volumetric laser endomicroscopy (VLE) (also known as frequency domain optical coherence tomography) are advanced endoscopic imaging modalities that may be useful in the diagnosis of dysplasia associated with Barrett’s esophagus (BE). We performed pCLE examination in ex-vivo EMR specimens and compared the diagnostic performance of using the current VLE scoring index (previously established as OCT-SI) and a novel VLE diagnostic algorithm (VLE-DA) for the detection of dysplasia. Methods A total of 27 patients with BE enrolled in a surveillance program at a tertiary-care center underwent 50 clinically indicated EMRs that were imaged with VLE and pCLE and classified into neoplastic (N = 34; high-grade dysplasia, intramucosal adenocarcinoma) and nonneoplastic (N = 16; low-grade dysplasia, nondysplastic BE), based on histology. Image datasets (VLE, N = 50; pCLE, N = 50) were rated by 3 gastroenterologists trained in the established diagnostic criteria for each imaging modality as well as a new diagnostic algorithm for VLE derived from a training set that demonstrated association of specific VLE features with neoplasia. Sensitivity, specificity, and diagnostic accuracy were assessed for each imaging modality and diagnostic criteria. Results The sensitivity, specificity, and diagnostic accuracy of pCLE for detection of BE dysplasia was 76% (95% confidence interval [CI], 59–88), 79% (95% CI, 53–92), and 77% (95% CI, 72–82), respectively. The optimal diagnostic performance of OCT-SI showed a sensitivity of 70% (95% CI, 52–84), specificity of 60% (95% CI, 36–79), and diagnostic accuracy of 67%; (95% CI, 58–78). The use of the novel VLE-DA showed a sensitivity of 86% (95% CI, 69–96), specificity of 88% (95% CI, 60–99), and diagnostic accuracy of 87% (95% CI, 86–88). The diagnostic accuracy of using the new VLE-DA criteria was significantly superior to the current OCT-SI (P < .01). Conclusion The use of a new VLE-DA showed enhanced diagnostic performance for detecting BE dysplasia ex vivo compared with the current OCT-SI. Further validation of this algorithm in vivo is warranted.

Volumetric Laser Endomicroscopy for Barrett’s Esophagus – Looking at the Fine Print

“…The NvisionVLETM system was used in all studies [23][24][25][26][27][28][29]. Volumetric laser endomicroscopy is a second-generation optical coherence tomography.…”

“…Long segment imaging can be obtained with an axial resolution of 7 µm, a transverse resolution of about 30 µm, and can reach an imaging depth of up to 2 to 3 mm. A total of 1200 images can be obtained in 96 secs [23][24][25][26].…”

“…Evans et al came up with a scoring method to aid in determining the severity of dysplasia (Table II) [30]. Figures 1-5 [23]. The authors devised a new algorithm named VLE-DA for detection of dysplasia in the background of BE.…”

“…It utilizes optical scattering of near-infrared light to generate cross-sectional images of the esophageal mucosa based on differences in tissue composition. Volumetric laser endomicroscopy has an axial resolution of 7 µm, a transverse resolution of about 30 µm, and can reach an imaging depth of up to 2 to 3 mm [21][22][23].…”

Computer-aided detection of early Barrett’s neoplasia using volumetric laser endomicroscopy

“…Recently, clinical VLE prediction models were developed for BE neoplasia showing good accuracy. 6,7 However, pilot studies using ex vivo and in vivo VLE data may suggest that full scan VLE interpretation by experts remains difficult. 8,9 In vivo case reports suggested that VLE could detect additional neoplasia, however, clinical trials in larger sample size are necessary to confirm these findings.…”