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

Abstract

Background Gastric cancer (GC) represents a significant global health burden with high morbidity and mortality, especially when diagnosed at advanced stages. Therefore, early detection of GC is critical. Probe-based confocal laser endomicroscopy (pCLE) is a new evolving technology that uses real-time, high-resolution imaging to inspect the mucosa at the cellular and microvascular level, using a confocal probe. Widespread studies using pCLE are limited at the current time. We aimed to investigate the diagnostic efficacy of this modality for the detection of GC. Methods Multiple databases were searched from inception until November 2021. The diagnostic performance of pCLE was assessed by calculating its sensitivity, specificity and accuracy for the detection of GC, using pooled proportions and 95% confidence intervals (CI) with a random-effects model. Heterogeneity was assessed using I 2 . Results Seven studies were included, with a total of 567 patients (mean age 61.7 years, 364 males). Pooled performance metrics of pCLE included a sensitivity of 87.9% (95%CI 81.4-92.4; P<0.001; I 2 =0%), specificity 96.5% (95%CI 91.5-98.6; P<0.001; I 2 =51.84%), and an accuracy of 94.7% (95%CI 89.5-97.4; P<0.001; I 2 =65.44%). Conclusions pCLE is a highly effective diagnostic modality for detecting GC. Larger, randomized controlled studies are needed to determine its role in daily practice compared to conventional endoscopic practices.

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

“…In one study, pCLE was able to diagnose AG and IM with 98% specificity [72]. In a recent meta-analysis that included seven studies, pCLE had a sensitivity of 87.9% (95% CI 81.4-92.4%), a specificity of 96.5% (95% CI 91.5-98.6%), and an accuracy of 94.7% (95% CI 89.5-97.4%) to diagnose GC [73].…”

“…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].…”

Role of Confocal Laser Endomicroscopy in Early Detection of Upper Gastrointestinal Malignancy in High Risk Patients

“…Recently, a latest endoscopic procedure, Confocal Laser Endoscopy (CLE), has emerged for diagnosing various gastrointestinal disorders (Tomizawa et al, 2022). Early detection of Barrett's esophagus, gastric cancer, and other upper gastrointestinal malignancies using CLE significantly improves prognosis, reduces healthcare costs, and has a substantial impact on mortality reduction (Canakis et al, 2022).…”