title: Optical biopsies by confocal endomicroscopy prevent additive endoscopic biopsies before endoscopic submucosal dissection in gastric epithelial neoplasias: a prospective, comparative study.
abstract: BACKGROUND
  Confocal laser endomicroscopy (CLE) allows real-time in vivo histologic evaluation of GI lesions. To our knowledge, there is no reported prospective study comparing endoscopic and optical biopsy using CLE before endoscopic submucosal dissection (ESD) with post-ESD histopathology.
  
  
  OBJECTIVE
  We compared endoscopic and optical biopsy before ESD and thereby assessed the ability of CLE to effectively diagnose and differentiate gastric epithelial neoplasia.
  
  
  METHODS
  Single tertiary-care center, prospective comparative study.
  
  
  METHODS
  Soonchunhyang University Hospital, between September 2009 and April 2010.
  
  
  METHODS
  This study involved 31 patients with 35 gastric epithelial neoplasias, previously diagnosed by endoscopic biopsy, who were scheduled for ESD.
  
  
  METHODS
  Target lesions were imaged in vivo by using CLE.
  
  
  METHODS
  The overall accuracy of endoscopic and CLE diagnosis was compared with post-ESD histopathology.
  
  
  RESULTS
  In histopathology after ESD, 11 of 35 lesions (31.5%) were adenomas and 24 (68.5%) were adenocarcinomas. The overall accuracy of CLE diagnosis of gastric adenomas and adenocarcinomas was significantly higher at 94.2% (95% confidence interval [CI], 81.3-98.4), versus 85.7% (95% CI, 70.6-93.7) for endoscopic biopsy (P = .031). The overall accuracy of CLE diagnosis of differentiated and undifferentiated adenocarcinomas also was higher (95.4%; 95% CI, 78.2-99.1) than that of endoscopic biopsy (84.2%; 95% CI, 62.4-94.4) but did not differ significantly (P = .146).
  
  
  CONCLUSIONS
  Single tertiary-care center experience and small patient number.
  
  
  CONCLUSIONS
  This study demonstrates the high accuracy of diagnosis of gastric epithelial neoplasia by using CLE. The use of CLE could possibly thus reduce the number of unnecessary biopsies and mistaken diagnoses before ESD.
authors.affiliation: Department of Internal Medicine, Institute of Digestive Research, Soonchunhyang University Hospital, Seoul, Korea.
authors.forename: Seong Ran
authors.initials: SR
authors.lastname: Jeon
authors.forename: Won Young
authors.initials: WY
authors.lastname: Cho
authors.forename: So Young
authors.initials: SY
authors.lastname: Jin
authors.forename: Young Koog
authors.initials: YK
authors.lastname: Cheon
authors.forename: Seok Reyol
authors.initials: SR
authors.lastname: Choi
authors.forename: Joo Young
authors.initials: JY
authors.lastname: Cho
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D000236:Adenoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D001706:Biopsy / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery