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Value of probe-based confocal laser endomicroscopy (pCLE) and dual focus narrow-band imaging (dNBI) in diagnosing early squamous cell neoplasms in esophageal Lugol's voiding lesions.

Prueksapanich P, Pittayanon R, Rerknimitr R, Wisedopas N, Kullavanijaya P - Endosc Int Open (2015)

Bottom Line: The other 14 lesions were histologically confirmed as non-neoplastic: active esophagitis, glycogenation with inflammation, acute ulcer, inlet patch, and unremarkable changes.Perhaps the trend of lower specificity of dNBI in this study was possibly because of the interference from Lugol's stain on the interpretation of intrapapillary capillary loops (IPCLs).Further study is required to seek a significant difference in the performance of dNBI and pCLE in a larger group of patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.

ABSTRACT

Background and study aims: Lugol's chromoendoscopy provides excellent sensitivity for the detection of early esophageal squamous cell neoplasms (ESCN), but its specificity is suboptimal. An endoscopy technique for real-time histology is required to decrease the number of unnecessary biopsies. This study aimed to compare the ESCN diagnostic capability of probed-based confocal laser endomicroscopy (pCLE) and dual focus narrow-band imaging (dNBI) in Lugol's voiding lesions.

Patients and methods: Patients with a history of head and neck cancer without dysphagia were recruited. Lugol's voiding lesions larger than 5 mm were sequentially characterized by dNBI and pCLE by two independent operators. Finally, all lesions larger than 5 mm were biopsied followed by histological analysis, which is considered to be the gold standard in cancer diagnosis. The primary outcomes were the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the accuracy of the two techniques.

Results: In total, 44 patients were enrolled with a mean age of 60 years; 80 % were male. Twenty-one Lugol's voiding lesions larger than 5 mm were detected in 12 patients. Seven lesions (33 %) from four patients were histologically diagnosed as ESCNs (four with high grade dysplasia and three with low grade dysplasia). The other 14 lesions were histologically confirmed as non-neoplastic: active esophagitis, glycogenation with inflammation, acute ulcer, inlet patch, and unremarkable changes. The sensitivity, specificity, PPV, NPV, and accuracy of pCLE vs. dNBI were 83 % vs. 85 %, 92 % vs. 62 %, 83 % vs. 54 %, 92 % vs. 89 %, and 89 % vs. 70 %, respectively (NS).

Conclusions: Asymptomatic patients with a history of head and neck cancer underwent Lugol's chromoendoscopy based ESCN surveillance. Further characterization of the Lugol's voiding lesions by advanced imaging showed that both pCLE and dNBI provided good sensitivity in diagnosing ESCN, and pCLE tended to provide higher specificity, PPV, and accuracy than dNBI. Perhaps the trend of lower specificity of dNBI in this study was possibly because of the interference from Lugol's stain on the interpretation of intrapapillary capillary loops (IPCLs). Further study is required to seek a significant difference in the performance of dNBI and pCLE in a larger group of patients.

No MeSH data available.


Related in: MedlinePlus

Probe-based confocal laser endomicroscopy (pCLE) shows the homogenous squamous epithelial cells with regular architecture and clearly visible borders. b Probe-based confocal laser endomicroscopy (pCLE) shows the inhomogeneous squamous epithelium with irregular architecture and without clearly visible borders between cells in the early esophageal squamous cell neoplasm (ESCN).
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FI167-2: Probe-based confocal laser endomicroscopy (pCLE) shows the homogenous squamous epithelial cells with regular architecture and clearly visible borders. b Probe-based confocal laser endomicroscopy (pCLE) shows the inhomogeneous squamous epithelium with irregular architecture and without clearly visible borders between cells in the early esophageal squamous cell neoplasm (ESCN).

Mentions: The pCLE interpretation was based on cellular and vascular criteria. As there were no previous criteria to diagnose ESCN by pCLE, we adopted the criteria from the previous study using eCLE. However, we accepted that there is a certain difference in scanning depth between pCLE and eCLE as pCLE provides a fixed scanning depth of 55 – 65 µm, whereas eCLE provides a wider range of adjustable scanning depth (0 – 250 µm). For cellular criteria, normal squamous epithelial cells were homogenous with regular architecture and clearly visible borders of the squamous cells (Fig. 2 a). In contrast, the neoplastic epithelium was inhomogeneous with irregular architecture of the squamous cells. In the majority of cases, these cells displayed no clearly visible border between the cells (Fig. 2 b). For vascular criteria, normal capillaries appeared regular without fluorescein leakage (Fig. 3 a), whereas neoplastic capillaries were irregular, twisted, dilated, and elongated (Fig. 3 b). Occasionally, fluorescein leakage (Fig. 3 b (arrow)) could also be observed 17.


Value of probe-based confocal laser endomicroscopy (pCLE) and dual focus narrow-band imaging (dNBI) in diagnosing early squamous cell neoplasms in esophageal Lugol's voiding lesions.

Prueksapanich P, Pittayanon R, Rerknimitr R, Wisedopas N, Kullavanijaya P - Endosc Int Open (2015)

Probe-based confocal laser endomicroscopy (pCLE) shows the homogenous squamous epithelial cells with regular architecture and clearly visible borders. b Probe-based confocal laser endomicroscopy (pCLE) shows the inhomogeneous squamous epithelium with irregular architecture and without clearly visible borders between cells in the early esophageal squamous cell neoplasm (ESCN).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554495&req=5

FI167-2: Probe-based confocal laser endomicroscopy (pCLE) shows the homogenous squamous epithelial cells with regular architecture and clearly visible borders. b Probe-based confocal laser endomicroscopy (pCLE) shows the inhomogeneous squamous epithelium with irregular architecture and without clearly visible borders between cells in the early esophageal squamous cell neoplasm (ESCN).
Mentions: The pCLE interpretation was based on cellular and vascular criteria. As there were no previous criteria to diagnose ESCN by pCLE, we adopted the criteria from the previous study using eCLE. However, we accepted that there is a certain difference in scanning depth between pCLE and eCLE as pCLE provides a fixed scanning depth of 55 – 65 µm, whereas eCLE provides a wider range of adjustable scanning depth (0 – 250 µm). For cellular criteria, normal squamous epithelial cells were homogenous with regular architecture and clearly visible borders of the squamous cells (Fig. 2 a). In contrast, the neoplastic epithelium was inhomogeneous with irregular architecture of the squamous cells. In the majority of cases, these cells displayed no clearly visible border between the cells (Fig. 2 b). For vascular criteria, normal capillaries appeared regular without fluorescein leakage (Fig. 3 a), whereas neoplastic capillaries were irregular, twisted, dilated, and elongated (Fig. 3 b). Occasionally, fluorescein leakage (Fig. 3 b (arrow)) could also be observed 17.

Bottom Line: The other 14 lesions were histologically confirmed as non-neoplastic: active esophagitis, glycogenation with inflammation, acute ulcer, inlet patch, and unremarkable changes.Perhaps the trend of lower specificity of dNBI in this study was possibly because of the interference from Lugol's stain on the interpretation of intrapapillary capillary loops (IPCLs).Further study is required to seek a significant difference in the performance of dNBI and pCLE in a larger group of patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.

ABSTRACT

Background and study aims: Lugol's chromoendoscopy provides excellent sensitivity for the detection of early esophageal squamous cell neoplasms (ESCN), but its specificity is suboptimal. An endoscopy technique for real-time histology is required to decrease the number of unnecessary biopsies. This study aimed to compare the ESCN diagnostic capability of probed-based confocal laser endomicroscopy (pCLE) and dual focus narrow-band imaging (dNBI) in Lugol's voiding lesions.

Patients and methods: Patients with a history of head and neck cancer without dysphagia were recruited. Lugol's voiding lesions larger than 5 mm were sequentially characterized by dNBI and pCLE by two independent operators. Finally, all lesions larger than 5 mm were biopsied followed by histological analysis, which is considered to be the gold standard in cancer diagnosis. The primary outcomes were the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the accuracy of the two techniques.

Results: In total, 44 patients were enrolled with a mean age of 60 years; 80 % were male. Twenty-one Lugol's voiding lesions larger than 5 mm were detected in 12 patients. Seven lesions (33 %) from four patients were histologically diagnosed as ESCNs (four with high grade dysplasia and three with low grade dysplasia). The other 14 lesions were histologically confirmed as non-neoplastic: active esophagitis, glycogenation with inflammation, acute ulcer, inlet patch, and unremarkable changes. The sensitivity, specificity, PPV, NPV, and accuracy of pCLE vs. dNBI were 83 % vs. 85 %, 92 % vs. 62 %, 83 % vs. 54 %, 92 % vs. 89 %, and 89 % vs. 70 %, respectively (NS).

Conclusions: Asymptomatic patients with a history of head and neck cancer underwent Lugol's chromoendoscopy based ESCN surveillance. Further characterization of the Lugol's voiding lesions by advanced imaging showed that both pCLE and dNBI provided good sensitivity in diagnosing ESCN, and pCLE tended to provide higher specificity, PPV, and accuracy than dNBI. Perhaps the trend of lower specificity of dNBI in this study was possibly because of the interference from Lugol's stain on the interpretation of intrapapillary capillary loops (IPCLs). Further study is required to seek a significant difference in the performance of dNBI and pCLE in a larger group of patients.

No MeSH data available.


Related in: MedlinePlus