Confocal laser endomicroscopy for in vivo diagnosis of gastric intraepithelial neoplasia: a feasibility study.
BACKGROUND
Confocal laser endomicroscopy (CLE) is a novel endoscopic modality that allows subsurface analysis of the gastric mucosa during ongoing endoscopy. Several studies have reported that this technique is of value in the diagnosis of premalignant lesions in the GI tract, but as yet no investigations have reported its application in the analysis of gastric intraepithelial neoplasia (GIN).


OBJECTIVE
To assess the feasibility of CLE for the identification and grading of GIN.


METHODS
Prospective double-blind feasibility study.


METHODS
Qilu Hospital, Shandong University, Jinan, China.


METHODS
CLE images of 33 patients were first evaluated to establish the diagnostic criteria for gastric lesions. Eligible patients were then prospectively investigated by CLE using the newly established criteria.


METHODS
All endoscopically suspicious lesions were examined by CLE, and CLE diagnoses were compared with corresponding histopathologic results.


METHODS
Sensitivity, specificity, and positive and negative likelihood ratios of CLE diagnosis of biopsy-proven intraepithelial neoplasia by per-lesion analysis.


RESULTS
The sensitivity, specificity, and positive and negative likelihood ratios of CLE diagnosis of GIN were 77.8%, 81.8%, 4.28, and 0.27, respectively. The mean κ value for interobserver agreement for the diagnosis of GIN was 0.70 among endoscopists and 0.71 between endoscopist and GI pathologist. Intraepithelial neoplasia score ≥5 differentiated high-grade from low-grade intraepithelial neoplasia with a sensitivity of 66.7% and a specificity of 88.0%.


CONCLUSIONS
Nonrandomized single-center study, limited number of patients.


CONCLUSIONS
CLE is an acceptable and potentially useful technology for the identification and grading of GIN in vivo. The diagnostic accuracy needs to be improved.
Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
Zhen
Z
Li
Tao
T
Yu
Xiu-Li
XL
Zuo
Xiao-Meng
XM
Gu
Cheng-Jun
CJ
Zhou
Rui
R
Ji
Chang-Qing
CQ
Li
Peng
P
Wang
Ting-Guo
TG
Zhang
Khek-Yu
KY
Ho
Yan-Qing
YQ
Li
D000328:Adult; D000368:Aged; D001706:Biopsy; D002278:Carcinoma in Situ / Q000473:pathology*; D002681:China; D003937:Diagnosis, Differential; D004311:Double-Blind Method; D005240:Feasibility Studies; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology*