title: Diagnostic performance of two confocal endomicroscopy systems in detecting Barrett's dysplasia: a pilot study using a novel bioprobe in ex vivo tissue.
abstract: BACKGROUND
  There are currently 2 existing confocal laser endomicroscopy (CLE) platforms: probe-based CLE (pCLE) and endoscope-based CLE (eCLE) systems, each with its own criteria for identifying dysplasia in Barrett's esophagus (BE). The diagnostic performance of these 2 systems has not been directly compared.
  
  
  METHODS
  Preclinical, feasibility study.
  
  
  OBJECTIVE
  We compared the interrater agreement and diagnostic performance of the pCLE and eCLE systems. In addition, we evaluated a new BE endomicroscopy criteria based on fluorescent glucose intensity uptake.
  
  
  METHODS
  Thirteen patients with Barrett's esophagus and high-grade dysplasia or early cancer undergoing 16 EMR.
  
  
  METHODS
  CLE imaging was performed using two different probes with 2-[N-(7-nitrobenz-2-oxa-1,3-diaxol-4-yl)amino]-2-deoxyglucose, a fluorescent glucose analog with preferential uptake in dysplastic mucosa to supply contrast. Four quadrants were imaged per specimen with a total of 64 imaged mucosal sites presented to three gastroenterologists.
  
  
  METHODS
  Interobserver agreement and accuracy for dysplasia was assessed of images classified according to Miami criteria, stacked eCLE images classified using the Mainz criteria and a novel fluorescence intensity criteria.
  
  
  RESULTS
  The interrater agreements were 0.17, 0.68, and 0.87 for the Miami, Mainz, and the fluorescence intensity criteria, respectively. Overall accuracy in detecting dysplasia was 37% (95% CI, 30.3-43.9), 44.3% (95% CI, 37.3-50.9), and 78.6% (95% CI, 72.2-83.3) for the Miami, Mainz, and the fluorescence intensity criteria, respectively.
  
  
  CONCLUSIONS
  This imaging technique and proposed fluorescence intensity criteria using 2-[N-(7-nitrobenz-2-oxa-1,3-diaxol-4-yl)amino]-2-deoxyglucose in EMR tissue will require in vivo validation and cannot be directly used with the current eCLE and pCLE clinical applications.
  
  
  CONCLUSIONS
  In this preclinical feasibility study, the use of an eCLE system with a topical fluorescent contrast in ex vivo EMR tissue demonstrated higher interrater agreement and accuracy.
authors.affiliation: Barrett's Esophagus Unit, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Emmanuel C
authors.initials: EC
authors.lastname: Gorospe
authors.forename: Cadman L
authors.initials: CL
authors.lastname: Leggett
authors.forename: Gang
authors.initials: G
authors.lastname: Sun
authors.forename: Marlys A
authors.initials: MA
authors.lastname: Anderson
authors.forename: Milli
authors.initials: M
authors.lastname: Gupta
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Penfield
authors.forename: Lori
authors.initials: L
authors.lastname: Lutzke
authors.forename: Jason T
authors.initials: JT
authors.lastname: Lewis
authors.forename: Louis M
authors.initials: LM
authors.lastname: Wong Kee Song
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
mesh_terms: D009327:4-Chloro-7-nitrobenzofurazan / Q000031:analogs & derivatives*; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology* / Q000601:surgery; D003847:Deoxyglucose / Q000031:analogs & derivatives*; D004945:Esophagoscopy / Q000295:instrumentation*; D004947:Esophagus / Q000473:pathology* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000295:instrumentation*; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D015588:Observer Variation; D010865:Pilot Projects
chemical_list: D005456:Fluorescent Dyes; D003847:Deoxyglucose; D009327:4-Chloro-7-nitrobenzofurazan; C098340:2-(N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino)-2-deoxyglucose