Reflectance confocal microscopy for the diagnosis of eosinophilic esophagitis: a pilot study conducted on biopsy specimens - 26/10/11
Reprint requests: Guillermo J. Tearney, MD, PhD, Harvard Medical School, Massachusetts General Hospital, and Wellman Center for Photomedicine, 40 Parkman Street, RSH 160A, Boston, MA 02114Riassunto |
Background |
Diagnosis of eosinophilic esophagitis (EoE) currently requires endoscopic biopsy and histopathologic analysis of the biopsy specimens to count intraepithelial eosinophils. Reflectance confocal microscopy (RCM) is an endomicroscopy technology that is capable of obtaining high-resolution, optically sectioned images of esophageal mucosa without the administration of exogenous contrast.
Objective |
In this study, we investigated the capability of a high-speed form of RCM, termed spectrally encoded confocal microscopy (SECM), to count intraepithelial esophageal eosinophils and characterize other microscopic findings of EoE.
Design |
A total of 43 biopsy samples from 35 pediatric patients and 8 biopsy samples from 8 adult patients undergoing EGD for EoE were imaged by SECM immediately after their removal and then processed for routine histopathology. Two SECM readers, trained on adult cases, prospectively counted intraepithelial eosinophils and detected the presence of abscess, degranulation, and basal cell hyperplasia on SECM images from the pediatric patients. A pathologist blinded to the SECM data analyzed the same from corresponding slides.
Setting |
The Gastrointestinal Unit, Massachusetts General Hospital.
Results |
Eosinophils by SECM demonstrated a higher reflectance than the surrounding cells and other inflammatory cells. There was good correlation between SECM and histology maximum eosinophil counts/high-power field (R = 0.76, P < .0001). Intra- and interobserver correlations for SECM counts were very good (R = 0.93 and R = 0.92, respectively; P < .0001). For the commonly used eosinophil count cutoff of 15 per high-power field, the sensitivity and specificity of SECM for EoE were 100%. The sensitivity and specificity for abscess, degranulation, and basal cell hyperplasia were 100% and 82%, 91% and 60%, and 94% and 80%, respectively. Intra- and interobserver agreements for these microscopic features of EoE were very good (κ = 0.9/0.9, 0.84/1.0, 0.91/0.81, respectively).
Limitation |
Ex vivo study.
Conclusions |
This study demonstrates that RCM can be used to accurately count intraepithelial eosinophils and identify other microscopic abnormalities associated with EoE on freshly excised biopsy samples. These findings suggest that RCM may be developed into a tool for assessing eosinophilic infiltration in the esophagus in vivo.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : CLE, 3D, EoE, H&E, HPF, pCLE, RCM, SD, SECM, TBIR
Mappa
| DISCLOSURE: The following authors disclosed a financial relationship relevant to this publication: Drs Tearney and Bouma consult for and receive nonclinical sponsored research from Ninepoint Medical Inc. Ninepoint Medical Inc. has a technology-licensing agreement with Massachusetts General Hospital. Some authors (G.J.T., B.E.B., H.Y., D.K.) have rights to receive royalties as a result of this licensing arrangement. Dr. Namati works as a consultant for and has equity interest in Ninepoint Medical Inc. The other authors disclosed no financial relationships relevant to this publication. This research was supported in part by National Institutes of Health (grant numbers R21CA122161 and R01DK091923). |
Vol 74 - N° 5
P. 992-1000 - novembre 2011 Ritorno al numero
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