Development of a new classification for in vivo diagnosis of duodenal epithelial tumors with confocal laser endomicroscopy: A pilot study.
OBJECTIVE
Confocal laser endomicroscopy (CLE) has been established for in vivo diagnosis of various gastrointestinal diseases. However, validated criteria for confocal diagnosis of duodenal tumors do not exist. Therefore, the aim of the present pilot study was to develop a novel classification for in vivo optical diagnosis of duodenal tumors using CLE.


METHODS
Consecutive patients with duodenal tumorous lesions were included. First, an initial classification system was developed which was then validated. Histopathology was used as a reference standard.


RESULTS
A simple classification system for in vivo diagnosis of duodenal epithelial tumors using CLE was developed. Sensitivity, specificity, and accuracy were 90%, 100%, and 97%, respectively. Positive and negative predictive values were calculated as 100% and 96%. The kappa coefficient representing consistency was 1 between observers and within each observer.


CONCLUSIONS
A new classification for in vivo diagnosis of duodenal epithelial tumors using confocal imaging has been developed. The new classification system allows adequate prediction of histology and could therefore be used to guide subsequent therapy of duodenal lesions.
Department of Gastroenterology, NTT Medical Center Tokyo.
Kouichi
K
Nonaka
Department of Gastroenterology, NTT Medical Center Tokyo.
Ken
K
Ohata
Department of Pathology, Sapporo-Kosei General Hospital, Sapporo.
Shin
S
Ichihara
Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Saitama.
Shinichi
S
Ban
Graduate School of Healthcare, Tokyo Healthcare University, Tokyo.
Yoshimitsu
Y
Hiejima
Department of Gastroenterology, NTT Medical Center Tokyo.
Yohei
Y
Minato
Department of Gastroenterology, NTT Medical Center Tokyo.
Tomoaki
T
Tashima
Department of Gastroenterology, NTT Medical Center Tokyo.
Yasushi
Y
Matsuyama
Department of Gastroenterology, NTT Medical Center Tokyo.
Maiko
M
Takita
Department of Gastroenterology, NTT Medical Center Tokyo.
Nobuyuki
N
Matsuhashi
Division of Technical Services, Kyodo Byori Inc., Kobe, Japan.
Rumi
R
Takasugi
Department of Medicine I, University Hospital Erlangen, Erlangen, Germany.
Helmut
H
Neumann
D000328:Adult; D000368:Aged; D004379:Duodenal Neoplasms / Q000145:classification* / Q000175:diagnosis; D004386:Duodenum / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results
classification; dripping method; duodenal epithelial tumor; fluorescein; probe-based confocal laser endomicroscopy