Diagnostic performance of two confocal endomicroscopy systems in detecting Barrett's dysplasia: a pilot study using a novel bioprobe in ex vivo tissue - 16/10/12
Reprint requests: Kenneth K. Wang, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905Résumé |
Background |
There are currently 2 existing confocal laser endomicroscopy (CLE) platforms: probe-based CLE (pCLE) and endoscope-based CLE (eCLE) systems, each with its own criteria for identifying dysplasia in Barrett's esophagus (BE). The diagnostic performance of these 2 systems has not been directly compared.
Design |
Preclinical, feasibility study.
Objectives |
We compared the interrater agreement and diagnostic performance of the pCLE and eCLE systems. In addition, we evaluated a new BE endomicroscopy criteria based on fluorescent glucose intensity uptake.
Patients |
Thirteen patients with Barrett's esophagus and high-grade dysplasia or early cancer undergoing 16 EMR.
Intervention |
CLE imaging was performed using two different probes with 2-[N-(7-nitrobenz-2-oxa-1,3-diaxol-4-yl)amino]-2-deoxyglucose, a fluorescent glucose analog with preferential uptake in dysplastic mucosa to supply contrast. Four quadrants were imaged per specimen with a total of 64 imaged mucosal sites presented to three gastroenterologists.
Main Outcome Measurements |
Interobserver agreement and accuracy for dysplasia was assessed of images classified according to Miami criteria, stacked eCLE images classified using the Mainz criteria and a novel fluorescence intensity criteria.
Results |
The interrater agreements were 0.17, 0.68, and 0.87 for the Miami, Mainz, and the fluorescence intensity criteria, respectively. Overall accuracy in detecting dysplasia was 37% (95% CI, 30.3-43.9), 44.3% (95% CI, 37.3-50.9), and 78.6% (95% CI, 72.2-83.3) for the Miami, Mainz, and the fluorescence intensity criteria, respectively.
Limitations |
This imaging technique and proposed fluorescence intensity criteria using 2-[N-(7-nitrobenz-2-oxa-1,3-diaxol-4-yl)amino]-2-deoxyglucose in EMR tissue will require in vivo validation and cannot be directly used with the current eCLE and pCLE clinical applications.
Conclusions |
In this preclinical feasibility study, the use of an eCLE system with a topical fluorescent contrast in ex vivo EMR tissue demonstrated higher interrater agreement and accuracy.
Le texte complet de cet article est disponible en PDF.Abbreviations : BE, CLE, eCLE, FIVE, HGD, IMCA, 2-NBDG, pCLE
Plan
| If you would like to chat with an author of this article, you may Contact Dr. Wang at wang.kenneth@mayo.edu. |
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| DISCLOSURE: The following author disclosed financial relationships relevant to this publication: Dr Wang, research support from NinePoint Medical, Oncoscope, CSA, Abbott Diagnostics. The other authors disclosed no financial relationships relevant to this publication. |
Vol 76 - N° 5
P. 933-938 - novembre 2012 Retour au numéro
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