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Pilot study on probe-based confocal laser endomicroscopy for colorectal neoplasms: an initial experience in Japan

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Abstract

Background

The aim of this pilot study is to investigate the diagnostic yield of probe-based confocal laser endomicroscopy (pCLE) in the evaluation of depth of invasion in colorectal lesions.

Methods

Patients with colorectal lesions eligible for either endoscopic treatment or surgery were enrolled in the study. Tumor’s depth of invasion was classified as mucosal or slight submucosal (M-SM1) and deep submucosal invasion or deeper (SM2 or deeper). White light endoscopy (WLE), magnifying narrow band imaging (M-NBI), and magnifying chromoendoscopy (M-CE) were used to assess colorectal lesions, and pCLE was used to identify tumor’s features related to SM2 or deeper. The diagnostic classification of depth of invasion was obtained by correlating pCLE findings with histology results (on-site diagnosis). All colorectal lesions were stratified by a second endoscopist who was blinded to any clinical and histological information with the use of WLE, M-NBI, M-CE, and pCLE (off-line review).

Results

A total of 22 colorectal lesions were analyzed: seven were adenoma, ten intramucosal cancer, and five SM2 or deeper cancer. With respect to pCLE findings, loss of crypt structure was seen in all SM2 or deeper cancers and only in one M-SM1 lesion. Sensitivity, specificity, and accuracy of WLE, M-NBI, and M-CE in off-line review were 60/94/86, 60/94/86, and 80/94/91%, respectively. Sensitivity/specificity/accuracy of pCLE in off-line review were 80/94/91%, respectively. The inter-observer agreement of pCLE between on-site diagnosis and off-line review was 0.64 (95%CI 0.27–1.0).

Conclusions

pCLE may represent a useful tool to evaluate the depth of invasion in colorectal lesions.

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Acknowledgements

We would like to thank Dr. Hiyoyuki Takamaru and Masau Sekiguchi, Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan, and Dr. Flaminia Purchiaroni, Wolfson Unit for Endoscopy, St Mark’s Hospital, London, UK, for her kind support to this paper. Moreover, we would like to thank the Japan Agency for Medical Research and Development (AMED), which supported this study under Grant Number 15ck0106028h0002.

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Authors and Affiliations

  1. Department of Surgery I, Dokkyo Medical University, Tochigi, Japan

    Seiichiro Abe, Taku Sakamoto, Hidetsugu Yamagishi & Hiroyuki Kato

  2. Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Seiichiro Abe, Yutaka Saito, Yusaku Tanaka, Taku Sakamoto, Masayoshi Yamada, Takeshi Nakajima & Takahisa Matsuda

  3. Division of Gastrointestinal Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan

    Yasuhiro Oono, Hiroaki Ikematsu & Tomonori Yano

  4. Department of pathology, National Cancer Center Hospital, Tokyo, Japan

    Shigeki Sekine

  5. Department of Pathology, National Cancer Center Hospital, East, Kashiwa, Japan

    Motohiro Kojima

Authors
  1. Seiichiro Abe
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  2. Yutaka Saito
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  3. Yasuhiro Oono
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  14. Hiroyuki Kato
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Corresponding author

Correspondence to Yutaka Saito.

Ethics declarations

The study was carried on according to the ethical principles included in the Declaration of Helsinki. As intravenous fluorescein for pCLE has not been approved yet for clinical use in Japan, prior to the start of the study, we obtained the approval from the institutional review board for off-label use of intravenous fluorescein. Written informed consent was obtained from all patients.

Conflict of interest

There was no conflict of interest to be disclosed in relation to this study.

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Abe, S., Saito, Y., Oono, Y. et al. Pilot study on probe-based confocal laser endomicroscopy for colorectal neoplasms: an initial experience in Japan. Int J Colorectal Dis 33, 1071–1078 (2018). https://doi.org/10.1007/s00384-018-3059-x

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  • DOI: https://doi.org/10.1007/s00384-018-3059-x

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