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Improved detection of incident dysplasia by probe-based confocal laser endomicroscopy in a Barrett's esophagus surveillance program.
Dig Dis Sci. 2013 Jan; 58(1):188-93.DD

Abstract

BACKGROUND

Probe-based confocal laser endomicroscopy (pCLE) is a new technique allowing in vivo detection of neoplastic tissue using a standard endoscope.

AIMS

Our aim was to compare the incident dysplasia detection rate of biopsies obtained by high-definition white light endoscopy (HD-WLE) or by pCLE in a cohort of patients with Barrett's esophagus (BE) participating in a surveillance program.

METHODS

Fifty of 100 patients underwent pCLE in addition to HD-WLE. Four-quadrant biopsy specimens according to the Seattle biopsy protocol were obtained in all patients to ensure standard-of-care. Diagnosis of dysplasia/neoplasia was made by a blinded gastrointestinal pathologist.

RESULTS

Incident high-grade dysplasia (HGD) and low-grade dysplasia (LGD) were diagnosed in 3/100 and in 16/100 cases. In the HD-WLE group, areas suspicious for neoplasia were not observed and dysplasia was diagnosed in 5/50 (10%) patients (one with HGD). In the pCLE group, areas suspicious for neoplasia were observed by pCLE in 21/50 (42%) patients; dysplasia was confirmed in 14 cases (28%) (two with HGD). The dysplasia detection rate was significantly higher in the pCLE group than in the HD-WLE group (P = 0.04). The sensitivity, specificity, positive and negative predictive values of pCLE for dysplasia were 100, 83, 67, and 100%, respectively.

CONCLUSIONS

Incident dysplasia can be more frequently detected by pCLE than by HD-WLE in BE. The higher dysplasia detection rate provided by pCLE could improve the efficacy of BE surveillance programs.

Authors+Show Affiliations

Endoscopia Digestiva, Nuovo Ospedale S. Agostino, Viale Giardini 1355, Modena, Italy. helga88@libero.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22875309

Citation

Bertani, Helga, et al. "Improved Detection of Incident Dysplasia By Probe-based Confocal Laser Endomicroscopy in a Barrett's Esophagus Surveillance Program." Digestive Diseases and Sciences, vol. 58, no. 1, 2013, pp. 188-93.
Bertani H, Frazzoni M, Dabizzi E, et al. Improved detection of incident dysplasia by probe-based confocal laser endomicroscopy in a Barrett's esophagus surveillance program. Dig Dis Sci. 2013;58(1):188-93.
Bertani, H., Frazzoni, M., Dabizzi, E., Pigò, F., Losi, L., Manno, M., Manta, R., Bassotti, G., & Conigliaro, R. (2013). Improved detection of incident dysplasia by probe-based confocal laser endomicroscopy in a Barrett's esophagus surveillance program. Digestive Diseases and Sciences, 58(1), 188-93. https://doi.org/10.1007/s10620-012-2332-z
Bertani H, et al. Improved Detection of Incident Dysplasia By Probe-based Confocal Laser Endomicroscopy in a Barrett's Esophagus Surveillance Program. Dig Dis Sci. 2013;58(1):188-93. PubMed PMID: 22875309.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved detection of incident dysplasia by probe-based confocal laser endomicroscopy in a Barrett's esophagus surveillance program. AU - Bertani,Helga, AU - Frazzoni,Marzio, AU - Dabizzi,Emanuele, AU - Pigò,Flavia, AU - Losi,Luisa, AU - Manno,Mauro, AU - Manta,Raffaele, AU - Bassotti,Gabrio, AU - Conigliaro,Rita, Y1 - 2012/08/09/ PY - 2012/05/03/received PY - 2012/07/18/accepted PY - 2012/8/10/entrez PY - 2012/8/10/pubmed PY - 2013/3/30/medline SP - 188 EP - 93 JF - Digestive diseases and sciences JO - Dig. Dis. Sci. VL - 58 IS - 1 N2 - BACKGROUND: Probe-based confocal laser endomicroscopy (pCLE) is a new technique allowing in vivo detection of neoplastic tissue using a standard endoscope. AIMS: Our aim was to compare the incident dysplasia detection rate of biopsies obtained by high-definition white light endoscopy (HD-WLE) or by pCLE in a cohort of patients with Barrett's esophagus (BE) participating in a surveillance program. METHODS: Fifty of 100 patients underwent pCLE in addition to HD-WLE. Four-quadrant biopsy specimens according to the Seattle biopsy protocol were obtained in all patients to ensure standard-of-care. Diagnosis of dysplasia/neoplasia was made by a blinded gastrointestinal pathologist. RESULTS: Incident high-grade dysplasia (HGD) and low-grade dysplasia (LGD) were diagnosed in 3/100 and in 16/100 cases. In the HD-WLE group, areas suspicious for neoplasia were not observed and dysplasia was diagnosed in 5/50 (10%) patients (one with HGD). In the pCLE group, areas suspicious for neoplasia were observed by pCLE in 21/50 (42%) patients; dysplasia was confirmed in 14 cases (28%) (two with HGD). The dysplasia detection rate was significantly higher in the pCLE group than in the HD-WLE group (P = 0.04). The sensitivity, specificity, positive and negative predictive values of pCLE for dysplasia were 100, 83, 67, and 100%, respectively. CONCLUSIONS: Incident dysplasia can be more frequently detected by pCLE than by HD-WLE in BE. The higher dysplasia detection rate provided by pCLE could improve the efficacy of BE surveillance programs. SN - 1573-2568 UR - https://www.unboundmedicine.com/medline/citation/22875309/Improved_detection_of_incident_dysplasia_by_probe_based_confocal_laser_endomicroscopy_in_a_Barrett's_esophagus_surveillance_program_ L2 - https://doi.org/10.1007/s10620-012-2332-z DB - PRIME DP - Unbound Medicine ER -