Characterization and identification of gastric hyperplastic polyps and adenomas by confocal laser endomicroscopy.
BACKGROUND
Management of gastric polyps depends on their histologic composition. A real-time in vivo histologic diagnosis would be valuable to an "on table" management decision. Confocal laser endomicroscopy (CLE), a new diagnostic tool, allows real-time in vivo histologic evaluations of gastrointestinal lesions. This study aimed to assess the feasibility and practicability of using CLE to identify and differentiate gastric hyperplastic polyps and adenomas.


METHODS
A total of 66 patients with previously diagnosed polyps were recruited for this study between January 2007 and August 2008 at Qilu Hospital, Shandong University, China. The CLE imaging of hyperplastic polyps and adenomas was performed, and the CLE diagnosis was compared with the gold standard of histopathologic diagnosis.


RESULTS
Imaging by CLE was successfully performed for 60 lesions of gastric hyperplastic polyps and 27 lesions of gastric adenomas. Compared with the surrounding background mucosa, gastric hyperplastic polyps and adenomas showed typical distinct appearances, respectively, by CLE. The overall accuracy of the in vivo CLE diagnosis of gastric hyperplastic polyps and adenomas during ongoing endoscopy was 90% (95% confidence interval [CI], 83-96%), and the overall accuracy of differentiating gastric hyperplastic polyps and adenomas by CLE was 97% (95% CI, 90-99%) after endoscopy. Intraobserver agreement was perfect (kappa = 0.92; 95% CI, 0.82-0.99), and interobserver agreement was also good (kappa = 0.83, 95% CI, 0.70-0.96).


CONCLUSIONS
This study characterized confocal images of gastric hyperplastic polyps and adenomas as well as the high accuracy of differentiating hyperplastic polyps and adenomas using CLE.
Li
Wen-Bo
WB
Department of Gastroenterology, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, 250012 Jinan, China.
Zuo
Xiu-Li
XL
Zuo
Fang
F
Gu
Xiao-Meng
XM
Yu
Tao
T
Zhao
You-An
YA
Zhang
Ting-Guo
TG
Zhang
Jian-Ping
JP
Li
Yan-Qing
YQ
D000167:Acriflavine; D000236:Adenoma / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D005260:Female; D005456:Fluorescent Dyes; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology; D018613:Microscopy, Confocal; D008875:Middle Aged; D011127:Polyps / Q000473:pathology*; D011230:Precancerous Conditions / Q000473:pathology; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology*
D005456:Fluorescent Dyes; D000167:Acriflavine