Diagnostic utility of probe-based confocal laser endomicroscopy in superficial non-ampullary duodenal epithelial tumors

Abstract

Background and study aims Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors (SNADETs) has not been established. Probe-based confocal laser endomicroscopy (pCLE: Cellvizio) provides real-time endomicroscopic analysis. We developed and validated a new pCLE classification of SNADET based on abnormal findings. Patients and methods pCLE scanning of 20 SNADET lesions including 16 adenomas and four carcinomas was retrospectively evaluated to explore abnormal pCLE findings in relation to histological features. Diagnostic yield of pCLE findings was prospectively evaluated in an additional 20 SNADET lesions including 16 adenomas and four carcinomas. Results In a retrospective study, we identified four abnormal pCLE findings of SNADETs: (1) dark epithelium, (2) columnar cells irregularly extending to the lumen, (3) distorted crypt structure, and (4) fluorescein leakage. Dark epithelium distinguished neoplastic lesions (adenomas and carcinomas) from non-neoplastic duodenal mucosa with a sensitivity of 90 % and a specificity of 100 %. Distorted crypt structure distinguished carcinomas from adenomas and non-neoplastic duodenal mucosa with a sensitivity of 100% and a specificity of 94 %. In the prospective study, the sensitivity and the specificity of the dark epithelium for the diagnosis of neoplastic lesions (adenomas + carcinomas) was 75% and 100 %. Sensitivity and the specificity of the distorted crypt structure for discrimination of carcinoma from adenoma were 100 % and 94 %, respectively. Conclusions The pCLE findings correlated with the histopathology of the SNADETs. Dark epithelium and distorted crypt structure were informative pCLE findings to predict presence of neoplasia and cancer in the SNADET, respectively. UMIN-CTR UMIN000013857 TRIAL REGISTRATION: Single-Center, prospective observational trial UMIN000013857 at

Endoscopic diagnosis and treatment of superficial non-ampullary duodenal epithelial tumors: A review

“…Likewise, Tahara et al . [ 52 ] indicated that the dark epithelium and distorted crypt structure are characteristic pCLE features of neoplasia and cancer in SNADETs, with a sensitivity and specificity of nearly 100%. In terms of ECS, Hirose et al .…”

Systematic interpretation of confocal laser endomicroscopy: larynx and pharynx confocal imaging score

“…In addition, we dissected an apron flap for total laryngectomy in 11 patients (84.6%; No. [3][4][5][6][7][8][9][10][11][12][13]. Microvascular defect reconstruction was necessary in 7 patients (53.8%).…”

“…Non-invasive methods to characterise mucosal changes of the head and neck region, such as narrow-band imaging, confocal laser imaging, optical coherence tomography and fluorescence endoscopy, have been emerging recently [1][2][3][4] . One method that has shown a potential advance regarding its broad application outside of experimental studies is confocal laser endomicroscopy (CLE), which has demonstrated its value in the fairly similar oesophageal, gastric and intestinal epithelium in a wide range of clinical applications [5][6][7][8] . CLE is usually performed with the systemic application of fluorescein, which stains the intercellular spaces and allows realtime, non-invasive examination of the surface epithelium, cell features and fine capillary system to resemble a histological examination in detail and resolution 9 .…”