Improved Detection of Incident Dysplasia by Probe-Based Confocal Laser Endomicroscopy in a Barrett’s Esophagus Surveillance Program
- Helga BertaniAffiliated withEndoscopia Digestiva, Nuovo Ospedale S. Agostino Email author
- , Marzio FrazzoniAffiliated withFisiopatologia Digestiva, Nuovo Ospedale S. Agostino
- , Emanuele DabizziAffiliated withEndoscopia Digestiva, Nuovo Ospedale S. Agostino
- , Flavia PigòAffiliated withEndoscopia Digestiva, Nuovo Ospedale S. Agostino
- , Luisa LosiAffiliated withAnatomia Patologica, Ospedale Policlinico
- , Mauro MannoAffiliated withEndoscopia Digestiva, Nuovo Ospedale S. Agostino
- , Raffaele MantaAffiliated withEndoscopia Digestiva, Nuovo Ospedale S. Agostino
- , Gabrio BassottiAffiliated withClinica di Gastroenterologia ed Epatologia
- , Rita ConigliaroAffiliated withEndoscopia Digestiva, Nuovo Ospedale S. Agostino
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Probe-based confocal laser endomicroscopy (pCLE) is a new technique allowing in vivo detection of neoplastic tissue using a standard endoscope.
Our aim was to compare the incident dysplasia detection rate of biopsies obtained by high-definition white light endoscopy (HD-WLE) or by pCLE in a cohort of patients with Barrett’s esophagus (BE) participating in a surveillance program.
Fifty of 100 patients underwent pCLE in addition to HD-WLE. Four-quadrant biopsy specimens according to the Seattle biopsy protocol were obtained in all patients to ensure standard-of-care. Diagnosis of dysplasia/neoplasia was made by a blinded gastrointestinal pathologist.
Incident high-grade dysplasia (HGD) and low-grade dysplasia (LGD) were diagnosed in 3/100 and in 16/100 cases. In the HD-WLE group, areas suspicious for neoplasia were not observed and dysplasia was diagnosed in 5/50 (10 %) patients (one with HGD). In the pCLE group, areas suspicious for neoplasia were observed by pCLE in 21/50 (42 %) patients; dysplasia was confirmed in 14 cases (28 %) (two with HGD). The dysplasia detection rate was significantly higher in the pCLE group than in the HD-WLE group (P = 0.04). The sensitivity, specificity, positive and negative predictive values of pCLE for dysplasia were 100, 83, 67, and 100 %, respectively.
Incident dysplasia can be more frequently detected by pCLE than by HD-WLE in BE. The higher dysplasia detection rate provided by pCLE could improve the efficacy of BE surveillance programs.
KeywordsConfocal laser endomicroscopy Barrett’s esophagus Esophageal dysplasia Esophageal adenocarcinoma
- Improved Detection of Incident Dysplasia by Probe-Based Confocal Laser Endomicroscopy in a Barrett’s Esophagus Surveillance Program
Digestive Diseases and Sciences
Volume 58, Issue 1 , pp 188-193
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- Springer US
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- Confocal laser endomicroscopy
- Barrett’s esophagus
- Esophageal dysplasia
- Esophageal adenocarcinoma
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- Author Affiliations
- 1. Endoscopia Digestiva, Nuovo Ospedale S. Agostino, Viale Giardini 1355, Modena, Italy
- 2. Fisiopatologia Digestiva, Nuovo Ospedale S. Agostino, Modena, Italy
- 3. Anatomia Patologica, Ospedale Policlinico, Modena, Italy
- 4. Clinica di Gastroenterologia ed Epatologia, Perugia, Italy