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Diagnostic values of dual focus narrow band imaging and probe-based confocal laser endomicroscopy in FAP-related duodenal adenoma.

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

Bottom Line: Histology from the matched lesion was used as the gold standard.A total of 55 matched biopsies (25 ampullas, 30 nonampullas) were performed.The sensitivity, specificity, post predictive value (PPV), negative predictive value (NPV), and accuracy of dNBI vs. pCLE from all duodenal lesions were 96.9 % vs. 93.8 %, 78.3 % vs. 81 %, 86.1 % vs. 88.2 %, 94.7 vs. 89.5 %, and 92.4 % vs. 88.6 %, respectively.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross Society, Bangkok, 10330, Thailand.

ABSTRACT

Background and study aims: Familial adenomatous polyposis (FAP) is associated with an increased risk of development of periampullary and nonampullary adenoma. Either routine biopsy or endoscopic removal of the lesion is generally required to identify the presence of adenoma. Because the risk of tissue sampling from the ampulla is high and nonampullary polyps are sometimes numerous, resection of all the lesions is time-consuming. This study aimed to evaluate the diagnostic values of duodenal adenoma by dual focus NBI (dNBI) and probe-based confocal endomicroscopy (pCLE) in FAP patients.

Patients and methods: The authors conducted a diagnostic study in a single tertiary-care referral center. Surveillance esophagogastroduodenoscopy with dNBI and pCLE was performed on 26 patients with FAP for real-time adenoma diagnosis by two different endoscopists; one used dNBI and the other pCLE. Histology from the matched lesion was used as the gold standard.

Results: A total of 55 matched biopsies (25 ampullas, 30 nonampullas) were performed. The sensitivity, specificity, post predictive value (PPV), negative predictive value (NPV), and accuracy of dNBI vs. pCLE from all duodenal lesions were 96.9 % vs. 93.8 %, 78.3 % vs. 81 %, 86.1 % vs. 88.2 %, 94.7 vs. 89.5 %, and 92.4 % vs. 88.6 %, respectively.

Conclusions: For surveillance of periampullary and nonampullary adenoma in patients with FAP, the real-time readings provided a high degree of diagnostic value when histology was used as the gold standard. (

Clinical trial registration number: NCT02162173).

No MeSH data available.


Related in: MedlinePlus

partial rim of white villi under white light represented non-adenoma (blue circle), b dense white villi under dNBI represented adenoma.
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FI216-4: partial rim of white villi under white light represented non-adenoma (blue circle), b dense white villi under dNBI represented adenoma.

Mentions: In the current series, dNBI and pCLE demonstrated lower specificity for adenoma in nonampullary than in ampullary lesions (65 % vs. 91 %). We found that the pattern of white villi could also be seen in non-neoplastic duodenal polyps, whereas the ampulla hardly contains non-neoplastic white villi. The white villi are believed to be lipid droplets which have substantially accumulated within the enterocytes 26. No supporting data yet exist to explain the mechanism of lipid accumulation in duodenal adenoma or how to differentiate them from non-neoplastic mucosa. However, we observed that the majority of neoplastic white villi appeared denser than non-neoplastic white villi (Fig. 4). Unfortunately, because all patterns of white villi were defined as adenoma in this study, false-positive readings may occur in some non-neoplastic lesions with white villi. On the other hand, a false-negative reading in a small duodenal adenoma also may occur if the pCLE probe (diameter 2.3 mm) is misplaced in nearby normal mucosa. In our experience, false-negative diagnosis by pCLE sometimes occurs in polyps smaller than 2.5 mm.


Diagnostic values of dual focus narrow band imaging and probe-based confocal laser endomicroscopy in FAP-related duodenal adenoma.

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

partial rim of white villi under white light represented non-adenoma (blue circle), b dense white villi under dNBI represented adenoma.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612245&req=5

FI216-4: partial rim of white villi under white light represented non-adenoma (blue circle), b dense white villi under dNBI represented adenoma.
Mentions: In the current series, dNBI and pCLE demonstrated lower specificity for adenoma in nonampullary than in ampullary lesions (65 % vs. 91 %). We found that the pattern of white villi could also be seen in non-neoplastic duodenal polyps, whereas the ampulla hardly contains non-neoplastic white villi. The white villi are believed to be lipid droplets which have substantially accumulated within the enterocytes 26. No supporting data yet exist to explain the mechanism of lipid accumulation in duodenal adenoma or how to differentiate them from non-neoplastic mucosa. However, we observed that the majority of neoplastic white villi appeared denser than non-neoplastic white villi (Fig. 4). Unfortunately, because all patterns of white villi were defined as adenoma in this study, false-positive readings may occur in some non-neoplastic lesions with white villi. On the other hand, a false-negative reading in a small duodenal adenoma also may occur if the pCLE probe (diameter 2.3 mm) is misplaced in nearby normal mucosa. In our experience, false-negative diagnosis by pCLE sometimes occurs in polyps smaller than 2.5 mm.

Bottom Line: Histology from the matched lesion was used as the gold standard.A total of 55 matched biopsies (25 ampullas, 30 nonampullas) were performed.The sensitivity, specificity, post predictive value (PPV), negative predictive value (NPV), and accuracy of dNBI vs. pCLE from all duodenal lesions were 96.9 % vs. 93.8 %, 78.3 % vs. 81 %, 86.1 % vs. 88.2 %, 94.7 vs. 89.5 %, and 92.4 % vs. 88.6 %, respectively.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross Society, Bangkok, 10330, Thailand.

ABSTRACT

Background and study aims: Familial adenomatous polyposis (FAP) is associated with an increased risk of development of periampullary and nonampullary adenoma. Either routine biopsy or endoscopic removal of the lesion is generally required to identify the presence of adenoma. Because the risk of tissue sampling from the ampulla is high and nonampullary polyps are sometimes numerous, resection of all the lesions is time-consuming. This study aimed to evaluate the diagnostic values of duodenal adenoma by dual focus NBI (dNBI) and probe-based confocal endomicroscopy (pCLE) in FAP patients.

Patients and methods: The authors conducted a diagnostic study in a single tertiary-care referral center. Surveillance esophagogastroduodenoscopy with dNBI and pCLE was performed on 26 patients with FAP for real-time adenoma diagnosis by two different endoscopists; one used dNBI and the other pCLE. Histology from the matched lesion was used as the gold standard.

Results: A total of 55 matched biopsies (25 ampullas, 30 nonampullas) were performed. The sensitivity, specificity, post predictive value (PPV), negative predictive value (NPV), and accuracy of dNBI vs. pCLE from all duodenal lesions were 96.9 % vs. 93.8 %, 78.3 % vs. 81 %, 86.1 % vs. 88.2 %, 94.7 vs. 89.5 %, and 92.4 % vs. 88.6 %, respectively.

Conclusions: For surveillance of periampullary and nonampullary adenoma in patients with FAP, the real-time readings provided a high degree of diagnostic value when histology was used as the gold standard. (

Clinical trial registration number: NCT02162173).

No MeSH data available.


Related in: MedlinePlus