title: Probe-based confocal laser endomicroscopy for indeterminate biliary strictures: refinement of the image interpretation classification.
abstract: Background. Accurate diagnosis and clinical management of indeterminate biliary strictures are often a challenge. Tissue confirmation modalities during Endoscopic Retrograde Cholangiopancreatography (ERCP) suffer from low sensitivity and poor diagnostic accuracy. Probe-based confocal laser endomicroscopy (pCLE) has been shown to be sensitive for malignant strictures characterization (98%) but lacks specificity (67%) due to inflammatory conditions inducing false positives. Methods. Six pCLE experts validated the Paris Classification, designed for diagnosing inflammatory biliary strictures, using a set of 40 pCLE sequences obtained during the prospective registry (19 inflammatory, 6 benign, and 15 malignant). The 4 criteria used included (1) multiple thin white bands, (2) dark granular pattern with scales, (3) increased space between scales, and (4) thickened reticular structures. Interobserver agreement was further calculated on a separate set of 18 pCLE sequences. Results. Overall accuracy was 82.5% (n = 40 retrospectively diagnosed) versus 81% (n = 89 prospectively collected) for the registry, resulting in a sensitivity of 81.2% (versus 98% for the prospective study) and a specificity of 83.3% (versus 67% for the prospective study). The corresponding interobserver agreement for 18 pCLE clips was fair (k = 0.37). Conclusion. Specificity of pCLE using the Paris Classification for the characterization of indeterminate bile duct stricture was increased, without impacting the overall accuracy.
authors: Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY 10021, USA.
authors: Michel
authors: 0000-0003-0836-6114
authors: M
authors: Kahaleh
authors: Endoscopic Unit, Paoli-Calmettes Institute, 232 Boulevard de Sainte Marguerite, 13273 Marseille Cedex 9, France.
authors: Marc
authors: M
authors: Giovannini
authors: Division of Digestive Diseases, Yale University, New Haven, CT 06520, USA.
authors: Priya
authors: P
authors: Jamidar
authors: Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, USA.
authors: S Ian
authors: SI
authors: Gan
authors: Endoscopy Unit, "A. Gemelli" University Hospital, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy.
authors: Paola
authors: P
authors: Cesaro
authors: Endoscopy Unit, Paoli-Calmettes Institute, 232 Boulevard de Sainte Marguerite, 13009 Marseille, France.
authors: Fabrice
authors: F
authors: Caillol
authors: Medicosurgical Department of Hepatogastroenterology, Saint-Philibert Hospital Centre, 59160 Lomme-lès-Lille, France.
authors: Bernard
authors: B
authors: Filoche
authors: Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY 10021, USA.
authors: Kunal
authors: K
authors: Karia
authors: Gastroenterology, University of Alabama, Birmingham, AL 35233, USA.
authors: Ioana
authors: I
authors: Smith
authors: Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY 10021, USA.
authors: Monica
authors: 0000-0001-6773-7080
authors: M
authors: Gaidhane
authors: Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors: Adam
authors: A
authors: Slivka