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Probe-based confocal laser endomicroscopy for evaluating the submucosal invasion of colorectal neoplasms

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Abstract

Background

Probe-based confocal laser endomicroscopy (pCLE) is a novel method for in vivo histological analysis of colorectal neoplasm mucosa, which provides meaningful information for the development of adequate therapeutic strategies. However, the in vivo histology of colorectal neoplasm submucosa has not been studied. We assessed the feasibility and safety of pCLE for evaluating colorectal submucosa, and identified and validated diagnostic criteria for submucosal carcinoma infiltration.

Methods

From March to July 2014, 83 pCLE videos of 51 lesions in 31 patients who underwent scheduled colonoscopic procedures for the removal of colorectal neoplasms were acquired consecutively. During the procedures, pCLE videos of the lesions and biopsy samples for histopathological analysis were acquired. Final histopathological results were used as the gold standard.

Results

Based on the confocal pattern, we classified colorectal submucosa findings as negative (superficial submucosa, deep submucosa, and submucosa with fibrosis) or indicative of carcinoma infiltration. Dark and irregular cell nests with irregular cell architecture and little or no mucin were seen in submucosal carcinoma infiltration. Based on rates of correlation with pathological findings, the sensitivity, specificity, and accuracy of the classification of submucosal carcinoma infiltration by two observers were 91.7, 86.8, and 88.0 %, respectively. In addition, the results showed good interobserver agreement for the detection of submucosal carcinoma infiltration (κ = 0.757, standard error = 0.102). No adverse events occurred during the procedures.

Conclusions

Submucosa assessment by pCLE is feasible and safe. pCLE is useful for the differentiation of normal submucosa from carcinoma infiltration, particularly when infiltration is accompanied by severe fibrosis. Large-scale prospective studies are needed to further evaluate the clinical impact of the use of pCLE during endoscopy.

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Acknowledgments

This study was supported by a research grant from Health and Medical Technology R&D Program (HI10C2020), Ministry of Health and Welfare, Korea.

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Author notes

  1. Bun Kim

    Present address: Center for Colon Cancer, Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Korea

Authors and Affiliations

  1. Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Bun Kim, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Won Ho Kim & Sung Pil Hong

  2. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

    Yon Hee Kim & Hoguen Kim

  3. Department of Medicine, The Graduate School, Yonsei University College of Medicine, Seoul, Korea

    Bun Kim

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  1. Bun Kim
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Correspondence to Sung Pil Hong.

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Disclosures

Drs. Bun Kim, Yon Hee Kim, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Won Ho Kim, Hoguen Kim, and Sung Pil Hong have no conflicts of interest or financial ties to disclose. Ministry of Health and Welfare, Korea, was not directly involved in the study design, data acquisition/interpretation, or manuscript preparation or review.

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Kim, B., Kim, Y.H., Park, S.J. et al. Probe-based confocal laser endomicroscopy for evaluating the submucosal invasion of colorectal neoplasms. Surg Endosc 31, 594–601 (2017). https://doi.org/10.1007/s00464-016-5003-x

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  • DOI: https://doi.org/10.1007/s00464-016-5003-x

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