Detection of cholangiocarcinoma in vivo using miniprobe-based confocal fluorescence microscopy.
OBJECTIVE
The preoperative diagnosis of cholangiocarcinoma is associated with a low sensitivity. To overcome this limitation, a new imaging modality was evaluated to detect neoplasia in vivo in the biliary tract.


METHODS
Fourteen patients with biliary strictures were examined. Mucosal imaging was performed with a miniaturized confocal laser scanning miniprobe introduced via the accessory channel of a cholangioscope. Thereafter, targeted biopsy specimens were taken from the same regions.


RESULTS
All strictures could be reached. Presence of irregular vessels use confocal laser microscopy enabled prediction of neoplasia with an accuracy rate of 86%, sensitivity of 83%, and specificity of 88%. The respective numbers for standard histopathology were 79%, 50%, and 100%. The mean signal-to-noise-ratio of laser microscopic images acquired from malignant strictures differed significantly from those of benign origin (1.8 +/- 0.8 vs 2.6 +/- 1.0; P = .005).


CONCLUSIONS
Miniprobe-based confocal laser scanning microscopy considerably increases sensitivity for the detection of biliary neoplasia and therefore represents a promising diagnostic approach.
Meining
Alexander
A
Department of Medicine II, Technical University of Munich, Munich, Germany. alexander.meining@lrz.tu-m.de
Frimberger
Eckart
E
Becker
Valentin
V
Von Delius
Stefan
S
Von Weyhern
Claus Hann
CH
Schmid
Roland M
RM
Prinz
Christian
C
D018281:Cholangiocarcinoma / Q000175:diagnosis*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D012680:Sensitivity and Specificity