Usefulness of confocal laser endomicroscopy to diagnose ulcerative colitis‐associated neoplasia

Abstract

Chromoendoscopy, narrow-band imaging (NBI), and confocal laser endomicroscopy (CLE) have been introduced in ulcerative colitis (UC)-associated neoplasia surveillance. We aimed to determine the ability of CLE to differentiate among UC-associated neoplasia (differentiated type or undifferentiated type), sporadic adenoma, and circumscribed regenerative lesions. Of 665 patients with UC, we carried out probe-based CLE (pCLE) on 12 patients with suspected UC-associated neoplasia in addition to magnifying chromoendoscopy with crystal violet and NBI. We compared pCLE findings with pathological diagnoses. pCLE could differentiate UC-associated differentiated cancer from other pathologies such as solitary adenoma and non-neoplastic circumscribed regenerative lesions on the basis of back-to-back orientation of crypts (P = 0.048), and UC-associated undifferentiated cancer from other pathologies on the basis of dark trabecular architecture (P = 0.015). Sensitivity, specificity, and accuracy of combination of back-to-back orientation of crypts and dark trabecular architecture for carcinoma or dysplasia were 100%, 83%, and 92%, respectively. In vivo microscopic observation with pCLE was helpful to evaluate the suspected UC-associated neoplasia.

Advanced diagnostic endoscopy in the lower gastrointestinal tract: A review of JGES core sessions

“…21 Sensitivity, specificity, and accuracy of a combination of back-to-back orientation of crypts and dark trabecular architecture for UC-associated carcinoma or dysplasia were 100%, 83%, and 92%, respectively. 21 Large-scale studies are needed to further evaluate the clinical impact of the use of CLE during colonoscopy. EC allows ultra-magnified images to be captured during endoscopy and has made possible the diagnosis of living tumor cells in vivo.…”

“…CLE is useful for diagnosis of histopathological findings and invasion depth of colorectal tumors . Also, CLE can predict the inflammation activity of ulcerative colitis (UC) . Sensitivity, specificity, and accuracy of a combination of back‐to‐back orientation of crypts and dark trabecular architecture for UC‐associated carcinoma or dysplasia were 100%, 83%, and 92%, respectively .…”

“…Also, CLE can predict the inflammation activity of ulcerative colitis (UC) . Sensitivity, specificity, and accuracy of a combination of back‐to‐back orientation of crypts and dark trabecular architecture for UC‐associated carcinoma or dysplasia were 100%, 83%, and 92%, respectively . Large‐scale studies are needed to further evaluate the clinical impact of the use of CLE during colonoscopy.…”

Endoscopic ultrasound‐guided needle‐based confocal laser endomicroscopy in gastrointestinal subepithelial lesions: Feasibility study

“…We also reported that probe-based CLE showed irregular dark nests in jejunal metastasis from cervical cancer, 16 disorganized irregular dark glands in early-stage gastric cancer covered by nontumorous regenerative epithelium or maturated atypical glands found after Helicobacter pylori eradication, 25 and back-to-back orientation of dark crypts in ulcerative colitis-associated differentiated adenocarcinoma and dark trabecular architecture in ulcerative colitis-associated undifferentiated adenocarcinoma. 26 The Miami classification system based on a consensus of probe-based CLE users to standardize categorization of images indicated that all cancers in the esophagus, stomach, colorectum, and biliary duct were characterized by disorganized structures of dark ("nonrefractile") epithelium or cells. 27 Whether the mechanism by which cancerous cells are unenhanced by fluorescein is ascribed to low influx or high efflux is unknown, but this disorganized structure of unenhanced cells is an important hallmark of malignancy.…”

Detection and characterization of colitis‐associated cancer/dysplasia: Based on reports from the JDDW 2017 and meta‐analyses of prospective studies concerning endoscopic procedure

“…At JDDW 2017 International Session 9, Nagasaka et al . used probe‐based CLE to observe lesions in 12 patients and detected back‐to‐back‐oriented crypts in CC/D, while branching was observed in tubular adenoma . Although the typical findings of CC/D on CLE remain to be explored, this technology may be useful for establishing a new diagnostic strategy based on histological as well as on molecular abnormalities when combined with molecular science.…”