Probe-based confocal endomicroscopy is accurate for differentiating gastric lesions in patients in a Western center

Abstract

ObjectiveProbe-based confocal laser endomicroscopy (pCLE) technique may improve the diagnosis of gastric mucosal lesions allowing acquisition of high-resolution in vivo images at the cellular and microvascular levels. This study aims to evaluate the accuracy of pCLE for the differential diagnosis of non-neoplastic and neoplastic gastric lesions. MethodsTwenty gastric mucosal lesions from 10 patients were evaluated during endoscopic procedure and were examined by pCLE. Diagnostic pCLE was followed by biopsies or endoscopic resection of suspected lesions. A senior pathologist evaluated the specimens and was blinded to the pCLE results.ResultsPatients’ mean age was 68.3 (range, 42−83) years and six were men. Thirteen suspicious flat or elevated lesions (classified as 0−Is, 0−IIa or 0−IIa + IIc) and seven pre-malignant lesions (atrophy and intestinal metaplasia) were evaluated. One patient was studied during his long-term follow-up after partial gastrectomy and presented severe atrophy, intestinal metaplasia, and xanthomas at the stump mucosa. The location of gastric lesions was in the body (n=10 lesions), the antrum (n=9) and the incisura angularis (n=1). All neoplastic lesions and all but one benign lesion were properly diagnosed by pCLE. pCLE incorrectly diagnosed one small antrum lesion as adenoma, however the final diagnosis was intestinal metaplasia. The final histological diagnosis was neoplastic in 9 and benign lesions in 11. In this small case series, pCLE accuracy was 95% (19/20 lesions).ConclusionspCLE is accurate for real time histology of gastric lesions. pCLE may change the management of patients with gastric mucosal lesions, guiding biopsies and endoscopic resection, and avoiding further diagnostic workup or unnecessary therapy.

The diagnostic performance of probe-based confocal laser endomicroscopy in the detection of gastric cancer: a systematic review and meta-analysis

“…These included 567 patients (mean age 61.7 years, 364 male) with 611 gastric lesions. The majority of studies were from Asia (South Korea [ 20 ], China [ 21 , 24 ], Japan [ 22 , 25 , 26 ]) and one study was conducted in Brazil [ 23 ]. All studies used the Gastroflex ultrahigh definition (UHD) miniprobe (Cellvizio Mauna Kea, Paris).…”

Endoscopic Imaging for the Diagnosis of Neoplastic and Pre-Neoplastic Conditions of the Stomach

“…Therefore, targeting the region with higher accuracy for a pathology assessment may have a relevant impact on treatment management, avoiding further diagnostic procedures for tissue sampling [71]. The use of pCLE optical diagnosis has been deeply studied for gastric IM, AG, and intraepithelial neoplasia [72][73][74], and it was shown that it contributes to distinguishing normal and neoplastic mucosa through the analysis of both cellular and vascular patterns [75]. In one study, pCLE was able to diagnose AG and IM with 98% specificity [72].…”

Diagnostic accuracy of probe-based confocal laser endomicroscopy and tissue sampling by endoscopic retrograde cholangiopancreatography in indeterminate biliary strictures: a meta‑analysis

“…The pCLE enables low-energy laser light to be focused and illuminated through its inner small hole to produce a tissue image, which improves the accuracy of targeted biopsy and realizes instant optical biopsy 4 . The pCLE has been used to assess the histopathology of the gastrointestinal tract in vivo 5 , 6 . The accuracy of pCLE in the diagnosis of gastrointestinal tumors has been demonstrated in previous studies 7 , 8 .…”