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Surgical Endoscopy

, Volume 30, Issue 7, pp 2879–2885 | Cite as

A pilot study of confocal laser endomicroscopy for diagnosing gastrointestinal mucosa-associated lymphoid tissue (MALT) lymphoma

  • Werner DolakEmail author
  • Barbara Kiesewetter
  • Leonhard Müllauer
  • Marius Mayerhoefer
  • Marlene Troch
  • Michael Trauner
  • Michael Häfner
  • Markus Raderer
  • Andreas Püspök
Article

Abstract

Background

Patients with gastrointestinal mucosa-associated lymphoid tissue (MALT) lymphoma require lifelong endoscopic follow-up. This study aimed to establish and evaluate confocal laser endomicroscopy (CLE) criteria for gastrointestinal MALT lymphoma.

Methods

This prospective trial was conducted after IRB approval at the Medical University of Vienna. Twenty-four consecutive patients (14 males and 10 females, median age 65 years) referred for staging or follow-up of (former) gastrointestinal MALT lymphoma underwent endosonography (EUS) and CLE including white light endoscopy (WLE) and conventional biopsy sampling of the upper gastrointestinal tract. CLE criteria of the disease were based on the first five patients with histologically proven MALT lymphoma. All CLE datasets were reviewed separately by two CLE experts. The diagnostic modalities were compared using conventional histology as the gold standard.

Results

Sixty-two percentages had a positive diagnosis of MALT lymphoma based on histology. The sensitivity was 80 % for EUS (0.51–0.95), 100 % for WLE (0.75–1) and 93 % for CLE (0.66–1); the specificity was 67 % for EUS (0.31–0.91), 23 % for WLE (0.04–0.60) and 100 % for CLE (0.63–1). The agreement with histology was moderate for EUS (kappa 0.47, p = 0.02), fair for WLE (kappa 0.26, p = 0.06) and almost perfect for CLE (kappa 0.91, p < 0.01). Expert evaluation identified all but one case of MALT lymphoma with excellent interobserver agreement (kappa 0.89, p < 0.01). In the case missed by CLE, MALT lymphoma involvement was restricted to deep tissue structures.

Conclusions

Despite minor technical limitations, CLE is a promising alternative to conventional biopsy sampling in patients with gastrointestinal MALT lymphoma.

ClinicalTrials.gov number

NCT01583699.

Keywords

Mucosa-associated lymphoid tissue (MALT) lymphoma Confocal laser endomicroscopy Endosonography 

Notes

Compliance with ethical standards

Disclosures

Werner Dolak, Barbara Kiesewetter, Leonhard Müllauer, Marius Mayerhoefer, Marlene Troch, Michael Trauner, Michael Häfner, Markus Raderer and Andreas Püspök have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Werner Dolak
    • 1
    Email author
  • Barbara Kiesewetter
    • 2
  • Leonhard Müllauer
    • 3
  • Marius Mayerhoefer
    • 4
  • Marlene Troch
    • 2
  • Michael Trauner
    • 1
  • Michael Häfner
    • 5
  • Markus Raderer
    • 2
  • Andreas Püspök
    • 1
  1. 1.Division of Gastroenterology and Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
  2. 2.Division of Oncology, Department of Internal Medicine IMedical University of ViennaViennaAustria
  3. 3.Clinical Institute of PathologyMedical University of ViennaViennaAustria
  4. 4.Department of Radiology and Nuclear MedicineMedical University of ViennaViennaAustria
  5. 5.Department of Internal MedicineSt. Elisabeth Hospital ViennaViennaAustria

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