title: Diagnostic accuracy of probe-based confocal laser endomicroscopy and narrow band imaging in detection of dysplasia in duodenal polyps.
abstract: OBJECTIVE
  To estimate the accuracy of probe-based confocal laser endomicroscopy (pCLE) and narrow band imaging (NBI), individually and in combination, for classification of duodenal polyps.
  
  
  BACKGROUND
  Ex vivo pathologic diagnosis of duodenal polyps causes time delay, requiring separate procedures for diagnosis and therapy. It also involves small risk of pancreatitis in ampullary adenomas and can make subsequent endoscopic mucosal resection more difficult by "tacking down" mucosa. In vivo diagnosis with pCLE and NBI may avoid these complications and may guide immediate therapy.
  
  
  METHODS
  During high-definition white light endoscopy, 1 endoscopist (M.B.W.) performed NBI and then, pCLE of duodenal sites. Matched tissue sampling or endoscopic mucosal resection was performed. Confocal videos were recorded, de-identified, and reviewed by same endoscopist, blinded to histopathology, 1 month later. Confocal features of dysplasia in Barrett esophagus were applied for detection of duodenal dysplasia.
  
  
  RESULTS
  Of 65 sites from 36 participants, 24 lesions showed dysplasia, whereas 41 polyps and control sites were nondysplastic on histopathology, used as standard reference. The accuracy, sensitivity, and specificity of pCLE were 83%, 92%, and 78%, whereas that of NBI were 80%, 83%, and 78%, respectively. In subset of 49 lesions with similar pCLE and NBI diagnosis, the accuracy, sensitivity, and specificity, improved significantly and was found to be 92%, 95%, and 90%, respectively.
  
  
  CONCLUSIONS
  Our study suggests that pCLE has superior sensitivity as compared with NBI for detection of dysplasia in duodenal polyps. Combined accuracy of pCLE and NBI approaches that of ex vivo pathology, which may help in avoiding biopsy sampling.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, FL 32224, USA.
authors.forename: Muhammad W
authors.initials: MW
authors.lastname: Shahid
authors.forename: Anna
authors.initials: A
authors.lastname: Buchner
authors.forename: Victoria
authors.initials: V
authors.lastname: Gomez
authors.forename: Murli
authors.initials: M
authors.lastname: Krishna
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Woodward
authors.forename: Massimo
authors.initials: M
authors.lastname: Raimondo
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003952:Diagnostic Imaging; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult