Real-time increased detection of neoplastic tissue in Barrett's esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial.
Real-time increased detection of neoplastic tissue in Barrett's esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial.
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DOI：
10.1016/j.gie.2011.04.004
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发表时间：
2011-09
影响因子：
7.7
通讯作者：
Wallace MB
中科院分区：
文献类型：
--
作者：
Sharma P;Meining AR;Coron E;Lightdale CJ;Wolfsen HC;Bansal A;Bajbouj M;Galmiche JP;Abrams JA;Rastogi A;Gupta N;Michalek JE;Lauwers GY;Wallace MB
基于探针的共聚焦激光显微内镜（pCLE）允许实时检测肿瘤性巴雷特食管（BE）组织。然而，pCLE在真实的时间的准确性尚未得到广泛的评价。比较pCLE加高清白光内镜（HD-WLE）与单独HD-WLE检测BE高度异型增生（HGD）和早期癌（EC）的灵敏度和特异性。国际、前瞻性、多中心、随机、对照试验。五个三级转诊中心。共有101例连续BE患者接受HGD/EC的监测或内镜治疗。所有患者均接受HD-WLE、窄带成像（NBI）和pCLE检查，并在获得活检样本前记录结果。HD-WLE和NBI的顺序随机化，由2名独立、设盲的内镜医师进行。记录HD-WLE或NBI和4象限随机位置上的所有可疑病变。通过pCLE检查这些位置，并在真实的时间内做出良性或肿瘤性（HGD/EC）组织的推定诊断。最后，从所有位置采集活检标本，并由对内窥镜和pCLE数据不知情的中心病理学家进行审查。pCLE的诊断特征。HD-WLE的敏感性和特异性分别为34.2%和92.7%，而HD-WLE或pCLE的敏感性和特异性分别为68.3%和87.8%（分别为P = 0.002和P <0.001）。HD-WLE或NBI的敏感性和特异性分别为45.0%和88.2%，而HD-WLE、NBI或pCLE的敏感性和特异性分别为75.8%和84.2%（分别为P = 0.01和P = 0.02）。与HD-WLE和HD-WLE或NBI相比，pCLE与HD-WLE和NBI联合使用分别能够识别2名和1名额外的HGD/EC患者，导致检测到所有HGD/EC患者，尽管没有统计学显著性。学术中心与丰富的人口。与HD-WLE相比，pCLE联合HD-WLE显著提高了BE患者中检测肿瘤形成的能力。这可以允许为BE患者的管理和后续治疗做出更明智的决定。
Probe-based confocal laser endomicroscopy (pCLE) allows real-time detection of neoplastic Barrett’s esophagus (BE) tissue. However, the accuracy of pCLE in real time has not yet been extensively evaluated. To compare the sensitivity and specificity of pCLE in addition to high-definition white-light endoscopy (HD-WLE) with HD-WLE alone for the detection of high-grade dysplasia (HGD) and early carcinoma (EC) in BE. International, prospective, multicenter, randomized, controlled trial. Five tertiary referral centers. A total of 101 consecutive BE patients presenting for surveillance or endoscopic treatment of HGD/EC. All patients were examined by HD-WLE, narrow-band imaging (NBI), and pCLE, and the findings were recorded before biopsy samples were obtained. The order of HD-WLE and NBI was randomized and performed by 2 independent, blinded endoscopists. All suspicious lesions on HD-WLE or NBI and 4-quadrant random locations were documented. These locations were examined by pCLE, and a presumptive diagnosis of benign or neoplastic (HGD/EC) tissue was made in real time. Finally, biopsies were taken from all locations and were reviewed by a central pathologist, blinded to endoscopic and pCLE data. Diagnostic characteristics of pCLE. The sensitivity and specificity for HD-WLE were 34.2% and 92.7%, respectively, compared with 68.3% and 87.8%, respectively, for HD-WLE or pCLE (P = .002 and P < .001, respectively). The sensitivity and specificity for HD-WLE or NBI were 45.0% and 88.2%, respectively, compared with 75.8% and 84.2%, respectively, for HD-WLE, NBI, or pCLE (P = .01 and P = .02, respectively). Use of pCLE in conjunction with HD-WLE and NBI enabled the identification of 2 and 1 additional HGD/EC patients compared with HD-WLE and HD-WLE or NBI, respectively, resulting in detection of all HGD/EC patients, although not statistically significant. Academic centers with enriched population. pCLE combined with HD-WLE significantly improved the ability to detect neoplasia in BE patients compared with HD-WLE. This may allow better informed decisions to be made for the management and subsequent treatment of BE patients.
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影响因子：
7.7
作者：
Wo, JM;Ray, MB;Wilson, MA
通讯作者：
Wilson, MA
影响因子：
29.4
作者：
Wolfsen, Herbert C.;Crook, Julia E.;Wallace, Michael B.
通讯作者：
Wallace, Michael B.
影响因子：
7.7
作者：
Kara, Mohammed A.;Peters, Femke P.;Bergman, Jacques J. G. H. M.
通讯作者：
Bergman, Jacques J. G. H. M.
影响因子：
12.6
作者：
Kiesslich, Ralf;Gossner, Liebwin;Neurath, Markus F.
通讯作者：
Neurath, Markus F.
影响因子：
9.3
作者：
Kara, MA;Peters, FP;Bergman, JJGHM
通讯作者：
Bergman, JJGHM