title: Improved detection of incident dysplasia by probe-based confocal laser endomicroscopy in a Barrett's esophagus surveillance program.
abstract: BACKGROUND
  Probe-based confocal laser endomicroscopy (pCLE) is a new technique allowing in vivo detection of neoplastic tissue using a standard endoscope.
  
  
  OBJECTIVE
  Our aim was to compare the incident dysplasia detection rate of biopsies obtained by high-definition white light endoscopy (HD-WLE) or by pCLE in a cohort of patients with Barrett's esophagus (BE) participating in a surveillance program.
  
  
  METHODS
  Fifty of 100 patients underwent pCLE in addition to HD-WLE. Four-quadrant biopsy specimens according to the Seattle biopsy protocol were obtained in all patients to ensure standard-of-care. Diagnosis of dysplasia/neoplasia was made by a blinded gastrointestinal pathologist.
  
  
  RESULTS
  Incident high-grade dysplasia (HGD) and low-grade dysplasia (LGD) were diagnosed in 3/100 and in 16/100 cases. In the HD-WLE group, areas suspicious for neoplasia were not observed and dysplasia was diagnosed in 5/50 (10%) patients (one with HGD). In the pCLE group, areas suspicious for neoplasia were observed by pCLE in 21/50 (42%) patients; dysplasia was confirmed in 14 cases (28%) (two with HGD). The dysplasia detection rate was significantly higher in the pCLE group than in the HD-WLE group (P = 0.04). The sensitivity, specificity, positive and negative predictive values of pCLE for dysplasia were 100, 83, 67, and 100%, respectively.
  
  
  CONCLUSIONS
  Incident dysplasia can be more frequently detected by pCLE than by HD-WLE in BE. The higher dysplasia detection rate provided by pCLE could improve the efficacy of BE surveillance programs.
authors.affiliation: Endoscopia Digestiva, Nuovo Ospedale S. Agostino, Viale Giardini 1355, Modena, Italy. helga88@libero.it
authors.forename: Helga
authors.initials: H
authors.lastname: Bertani
authors.forename: Marzio
authors.initials: M
authors.lastname: Frazzoni
authors.forename: Emanuele
authors.initials: E
authors.lastname: Dabizzi
authors.forename: Flavia
authors.initials: F
authors.lastname: Pigò
authors.forename: Luisa
authors.initials: L
authors.lastname: Losi
authors.forename: Mauro
authors.initials: M
authors.lastname: Manno
authors.forename: Raffaele
authors.initials: R
authors.lastname: Manta
authors.forename: Gabrio
authors.initials: G
authors.lastname: Bassotti
authors.forename: Rita
authors.initials: R
authors.lastname: Conigliaro
mesh_terms: D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy; D004938:Esophageal Neoplasms / Q000175:diagnosis; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D012680:Sensitivity and Specificity