Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of gastric subepithelial tumors: a pilot study
Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of gastric subepithelial tumors: a pilot study
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超声内镜引导针基共聚焦激光内镜诊断胃上皮下肿瘤：一项初步研究
DOI：
10.1055/a-0790-8436
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发表时间：
2019-06-01
期刊：
影响因子：
9.3
通讯作者：
Li, Yan-Qing
中科院分区：
文献类型：
--
作者：
Zhang, Ming-Ming;Zhong, Ning;Li, Yan-Qing
背景现有技术对胃上皮下肿瘤（SETs）的诊断率不理想。这项前瞻性研究的目的是开发基于针的共聚焦激光显微内镜检查（nCLE）的胃SETs的诊断标准，并评估诊断的有效性，可行性和安全性的内镜超声引导nCLE（EUS-nCLE）hMethodsEligible患者进行前瞻性招募EUS-nCLE。4名非盲研究者评价了nCLE视频和相应的组织病理学，以制定nCLE标准。3个月后，由一名内窥镜医生离线审查记录的nCLE视频。图像质量（5点量表，1 =差，5 =非常好）和观察者间的协议进行了assessed.ResultsAll 33例患者进行了成功的EUS-nCLE程序。 建立了胃SET的nCLE标准。离线nCLE的总体准确性显著高于单独EUS（87.9% vs. 63.6%;P= 0.02）。 平均图像质量评分为3.9分。观察者间一致性的kappa值分别为：胃肠道间质瘤0.66，异位胰腺0.89，平滑肌瘤0.58，胃癌0.72。
BackgroundThe diagnostic yield of current techniques for gastric subepithelial tumors (SETs) is suboptimal. This prospective study aimed to develop diagnostic criteria for needle-based confocal laser endomicroscopy (nCLE) of gastric SETs, and to evaluate the diagnostic efficacy, feasibility, and safety of endoscopic ultrasound-guided nCLE (EUS-nCLE).MethodsEligible patients were prospectively recruited to undergo EUS-nCLE. Four unblinded investigators evaluated nCLE videos and corresponding histopathology to develop the nCLE criteria. The recorded nCLE videos were reviewed off-line by one endoscopist 3 months later. Image quality (five-point scale, 1 = poor and 5 = very good) and the interobserver agreements were assessed.ResultsAll 33 patients underwent successful EUS-nCLE procedures. The nCLE criteria for gastric SETs were established. Overall accuracy of off-line nCLE was significantly higher than that of EUS alone (87.9 % vs. 63.6 %;P= 0.02). The mean image quality score was 3.9. The kappa values of the interobserver agreements were 0.66 for gastrointestinal stromal tumor, 0.89 for ectopic pancreas, 0.58 for leiomyoma, and 0.72 for carcinoma.ConclusionsEUS-nCLE was feasible and safe to accurately diagnose gastric SETs.