Accuracy of probe-based confocal laser endomicroscopy (pCLE) compared to random biopsies during endoscopic surveillance of Barrett's esophagus.
Accuracy of probe-based confocal laser endomicroscopy (pCLE) compared to random biopsies during endoscopic surveillance of Barrett's esophagus.
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DOI：
10.1055/s-0043-124868
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发表时间：
2018-04
影响因子：
2.6
通讯作者：
Zfass A
中科院分区：
文献类型：
--
作者：
Shah T;Lippman R;Kohli D;Mutha P;Solomon S;Zfass A
对于巴雷特食管（BE）的监测，目前的随机四象限活检标准错过了10 - 50%的食管肿瘤，并且不允许实时决策。基于探针的共聚焦激光内镜（pCLE）允许在上内镜检查期间对食管黏膜进行实时的活体组织学评估。在常规临床实践中，比较pCLE与四象限活检准确性的前瞻性研究尚缺乏。连续的BE患者接受高清晰度白光和窄带成像，然后进行pCLE和靶向活检或粘膜切除术。在同一疗程中进行了四象限活检。前瞻性记录基线变量、实时pCLE解释和组织学结果。对pCLE序列和组织学标本进行盲法专家审查。64例患者的样本量是基于3%的高级别发育不良（HGD）或癌症的估计患病率先验计算的。研究共纳入66例患者。HGD或癌症患病率为4.55%。实时和盲法pCLE都能正确识别所有癌症病例。对于主要结果，与非盲法病理学解释相比，实时pCLE对HGD/癌症的特异性为98%，敏感性仅为67%。对于HGD和癌症，实时和盲法子宫内膜显微镜之间的观察者间一致（kappa = 0.6）。在75%的盲法和非盲法病理解释为低级别发育不良的病例中，pCLE发现了发育不良。pCLE在检测异常增生和癌症方面具有高特异性，但较低的灵敏度可能限制其在常规BE监测中的应用。pCLE可能在根除治疗前实时确认LGD。
For surveillance of Barrett’s esophagus (BE), the current standard of random 4-quadrant biopsies misses 10 – 50 % of esophageal neoplasms, and does not permit real-time decision-making. Probe-based confocal laser endomicroscopy (pCLE) permits real-time in vivo histologic assessment of esophageal mucosa during upper endoscopy. Prospective studies comparing the accuracy of pCLE to 4-quadrant biopsies in routine clinical practice are lacking. Consecutive patients with BE underwent high definition white light and narrow-band imaging followed by pCLE and targeted biopsy or mucosal resection. Four-quadrant biopsies were obtained during the same session. Baseline variables, real-time pCLE interpretation, and histology results were prospectively recorded. Blinded expert review of pCLE sequences and histology specimens was performed. A sample size of 64 patients was calculated a priori based on 3 % estimated prevalence of high grade dysplasia (HGD) or cancer. In total, 66 patients were included in the study. The prevalence of HGD or cancer was 4.55 %. Both real-time and blinded pCLE correctly identified all cases of cancer. For the primary outcome, real-time pCLE was 98 % specific but only 67 % sensitive for HGD/cancer compared to non-blinded pathologist interpretation. For HGD and cancer, inter-observer agreement was substantial between real-time and blinded endomicroscopists (kappa = 0.6). pCLE identified dysplasia in 75 % of cases where both blinded and unblinded pathology interpretation was low grade dysplasia. pCLE demonstrates high specificity for detecting dysplasia and cancer, but lower sensitivity may limit its utility in routine BE surveillance. pCLE may have a role in confirming LGD in real-time before eradication therapy.