title: Diagnostic value of confocal laser endomicroscopy for gastric superficial cancerous lesions.
abstract: BACKGROUND
  The identification of gastric superficial cancerous lesions based on conventional white-light endoscopy (WLE) is challenging, and histological analysis remains the 'gold standard' for the final diagnosis. Confocal laser endomicroscopy (CLE) can provide in vivo histological observation without the need for biopsy.
  
  
  OBJECTIVE
  To develop and evaluate CLE imaging criteria for gastric superficial cancerous lesions and to compare the diagnostic value of real-time integrated CLE (iCLE) and WLE alone in distinguishing gastric superficial cancerous lesions.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Qilu Hospital, Shandong University, Jinan, China.
  
  
  METHODS
  A total of 182 patients were enrolled into phase I and 1786 patients were enrolled into phase II.
  
  
  METHODS
  CLE images were blindly evaluated after endoscopy in phase I, and real-time iCLE diagnosis during endoscopy was compared with WLE diagnosis by using histopathology as a gold standard in phase II.
  
  
  METHODS
  The validity and reliability of the CLE diagnosis for identifying gastric superficial cancerous lesions.
  
  
  RESULTS
  Off-line CLE diagnosis for early gastric cancers had a high sensitivity (88.1%) and specificity (98.6%). When the two-tiered CLE classification of non-cancerous lesions and cancer/high-grade intraepithelial neoplasia (HGIN) lesions was introduced, CLE diagnosis led to a higher sensitivity (90.2%) and specificity (98.5%) (phase I). Real-time iCLE diagnosis had a higher sensitivity (88.9%), specificity (99.3%) and accuracy (98.8%) for gastric superficial cancer/HGIN lesions than WLE diagnosis (sensitivity, 72.2%; specificity, 95.1%; and accuracy, 94.1%) (p < 0.05) (phase II). Limitations This was a single-centre study.
  
  
  CONCLUSIONS
  CLE can be used to identify gastric superficial cancer/HGIN lesions with high validity and reliability.
authors.affiliation: Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China. liyanqing@sdu.edu.cn
authors.forename: Wen-Bo
authors.initials: WB
authors.lastname: Li
authors.forename: Xiu-Li
authors.initials: XL
authors.lastname: Zuo
authors.forename: Chang-Qing
authors.initials: CQ
authors.lastname: Li
authors.forename: Fang
authors.initials: F
authors.lastname: Zuo
authors.forename: Xiao-Meng
authors.initials: XM
authors.lastname: Gu
authors.forename: Tao
authors.initials: T
authors.lastname: Yu
authors.forename: Chuan-Lian
authors.initials: CL
authors.lastname: Chu
authors.forename: Ting-Guo
authors.initials: TG
authors.lastname: Zhang
authors.forename: Yan-Qing
authors.initials: YQ
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology*; D005260:Female; D005773:Gastroscopy; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000473:pathology*