Probe‐based confocal laser endomicroscopy versus biopsies in the diagnostics of oesophageal and gastric lesions: A prospective, pathologist‐blinded study. Issue 4 (1st May 2020)

• Record Type: Journal Article
• Authors: Kollar, Marek; Krajciova, Jana; Prefertusova, Lucia; Sticova, Eva; Maluskova, Jana; Vackova, Zuzana; Martinek, Jan
• Is Part Of: United European Gastroenterology journal. Volume 8:Issue 4(2020)
• Page Start: 436
• Page End: 443
• Publication Date: 2020-05-01
• Subjects: Confocal laser endomicroscopy -- oesophageal and gastric cancer; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640620904865
• Languages: English
• ISSNs: 2050-6406

Abstract

Abstract : Background and aim: Probe‐based confocal laser endomicroscopy (pCLE) provides real‐time microscopic visualisation. Our aim was to compare the diagnostic accuracy of pCLE with standard biopsies in patients with visible oesophageal or gastric lesions. Methods: This was a single‐centre, prospective, pathologist‐blinded study. Patients underwent high‐resolution endoscopy, and lesions were examined by pCLE followed by standard biopsies. A definitive diagnosis was determined from resection specimen. Main outcomes were overall diagnostic accuracy, sensitivity, specificity and positive and negative predictive values. Results: We examined 74 lesions in 67 patients. Definitive diagnoses revealed 34 malignant and 40 non‐malignant lesions. pCLE diagnosis was correct in 89.2% (66/74), while diagnosis based on biopsy was correct in 85% (57/67; p = 0.6). The overall diagnostic accuracy of biopsies was 85% (76–94%) and that of pCLE was 89% (79–96%). pCLE correctly diagnosed malignant lesions, comprising oesophageal adenocarcinoma, oesophageal squamous‐cell cancer or gastric adenocarcinoma, in 88.2% (30/34) of cases, while biopsy was correctly diagnosed in 75.9% (22/29; p = 0.3). Sensitivity and specificity to diagnose a malignant lesion were 75.9% (95% confidence interval (CI) 56–89%) and 100% (95% CI 90–100%) for biopsies and 88.2% (95% CI 72–97%) and 92% (95% CI 79–98%) for pCLE. No differences between biopsies and pCLE were found with regard to sensitivity, specificity to diagnose dysplastic and benign lesions ( p > 0.2). Conclusion: pCLE provides satisfactory diagnostic accuracy comparable with standard biopsies in patients with oesophageal or gastric lesions. ClinicalTrials.gov identifier: NCT0292049)