In vivo histopathology for detection of gastrointestinal neoplasia with a portable, confocal miniprobe: an examiner blinded analysis.
OBJECTIVE
Confocal fluorescence microscopy (CFM) has been mentioned to be a promising tool for in vivo histology. Recently, a portable confocal miniprobe has been developed. Our aim was to evaluate the potential benefit of CFM for detection of gastrointestinal neoplasia.


METHODS
A total of 47 patients with known or suspected neoplasia in the upper (n = 34) or lower gastrointestinal tract (n = 13) were examined with standard endoscopes. After mucolyis with 5-10 mL of acetic acid 1.5%, chromoendoscopy with 2-5 mL cresyl violet 0.25% was performed, with the substance also being used as a fluorophore for CFM. Real-time video sequences were recorded. Thereafter, biopsies were taken or mucosectomy/polypectomy was performed from the same examined area. All stored sequences were put into a random order and assessed by a pathologist and a gastroenterologist both blinded to any data.


RESULTS
A total of 119 CFM video sequences were recorded of 85 benign or 34 neoplastic areas. Quality of CFM images was regarded too low in 24 (pathologist) and 14 sequences (gastroenterologist). For the pathologist, accuracy of CFM detecting neoplasia was 92.6% (suitable images) and 73.9% (intention to diagnose). The respective accuracy values for the gastroenterologist were 92.4% (suitable images) and 81.5% (intention to diagnose). Agreement between CFM and histopathology was excellent (kappa values, 0.821 and 0.817).


CONCLUSIONS
We have demonstrated that CFM with a miniprobe has the potential to diagnose neoplasia during ongoing endoscopy. This system has the advantage that it can be used with standard endoscopes. Further studies are warranted for validation.
Meining
Alexander
A
II Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. alexander.meining@lrz.tum.de
Saur
Dieter
D
Bajbouj
Monther
M
Becker
Valentin
V
Peltier
Eric
E
Höfler
Heinz
H
von Weyhern
Claus Hann
CH
Schmid
Roland M
RM
Prinz
Christian
C
D048588:Benzoxazines; D001706:Biopsy; D003287:Contrast Media / Q000008:administration & dosage; D016099:Endoscopy, Gastrointestinal; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018613:Microscopy, Confocal / Q000295:instrumentation*; D008856:Microscopy, Fluorescence; D018715:Microscopy, Video; D010078:Oxazines / Q000008:administration & dosage; D012680:Sensitivity and Specificity
D048588:Benzoxazines; D003287:Contrast Media; D010078:Oxazines; C028911:cresyl violet