Diagnostic Accuracy of Probe-based Confocal Laser Endomicroscopy and Narrow Band Imaging in Detection of Dysplasia in Duodenal Polyps
- 1 May 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Clinical Gastroenterology
- Vol. 46 (5), 382-389
- https://doi.org/10.1097/mcg.0b013e318247f375
Abstract
Goals: To estimate the accuracy of probe-based confocal laser endomicroscopy (pCLE) and narrow band imaging (NBI), individually and in combination, for classification of duodenal polyps. Background: Ex vivo pathologic diagnosis of duodenal polyps causes time delay, requiring separate procedures for diagnosis and therapy. It also involves small risk of pancreatitis in ampullary adenomas and can make subsequent endoscopic mucosal resection more difficult by "tacking down" mucosa. In vivo diagnosis with pCLE and NBI may avoid these complications and may guide immediate therapy. Study: During high-definition white light endoscopy, 1 endoscopist (M.B.W.) performed NBI and then, pCLE of duodenal sites. Matched tissue sampling or endoscopic mucosal resection was performed. Confocal videos were recorded, de-identified, and reviewed by same endoscopist, blinded to histopathology, 1 month later. Confocal features of dysplasia in Barrett esophagus were applied for detection of duodenal dysplasia. Results: Of 65 sites from 36 participants, 24 lesions showed dysplasia, whereas 41 polyps and control sites were nondysplastic on histopathology, used as standard reference. The accuracy, sensitivity, and specificity of pCLE were 83%, 92%, and 78%, whereas that of NBI were 80%, 83%, and 78%, respectively. In subset of 49 lesions with similar pCLE and NBI diagnosis, the accuracy, sensitivity, and specificity, improved significantly and was found to be 92%, 95%, and 90%, respectively. Conclusions: Our study suggests that pCLE has superior sensitivity as compared with NBI for detection of dysplasia in duodenal polyps. Combined accuracy of pCLE and NBI approaches that of ex vivo pathology, which may help in avoiding biopsy sampling.Keywords
This publication has 32 references indexed in Scilit:
- The learning curve of in vivo probe-based confocal laser endomicroscopy for prediction of colorectal neoplasiaGastrointestinal Endoscopy, 2011
- Transparent cap improves patients' tolerance of colonoscopy and shortens examination time by inexperienced endoscopistsJournal of Digestive Diseases, 2010
- Cap-fitted colonoscopy: a randomized, tandem colonoscopy study of adenoma miss ratesGastrointestinal Endoscopy, 2010
- 511l: The Safety of Duodenal Endoscopic Mucosal Resection (EMR) in Non-Ampullary Lesions: A Study of Relative RiskGastrointestinal Endoscopy, 2010
- S1390: Evaluating Associations With Complications in Endoscopic Mucosal Resection (EMR)Gastrointestinal Endoscopy, 2010
- Recognition of surface mucosal and vascular patterns of colon polyps by using narrow-band imaging: interobserver and intraobserver agreement and prediction of polyp histologyGastrointestinal Endoscopy, 2009
- Novel endoscopic observation in Barrett’s oesophagus using high resolution magnification endoscopy and narrow band imagingAlimentary Pharmacology & Therapeutics, 2007
- Toward better imaging of Barrett's esophagus—see more, biopsy less!Gastrointestinal Endoscopy, 2006
- Detection and classification of the mucosal and vascular patterns (mucosal morphology) in Barrett's esophagus by using narrow band imagingGastrointestinal Endoscopy, 2006
- Duodenalpolypen: Häufigkeit, histologisches Substrat und BedeutungDeutsche Medizinische Wochenschrift (1946), 1984