Probe‐based confocal laser endomicroscopy versus biopsies in the diagnostics of oesophageal and gastric lesions: A prospective, pathologist‐blinded study
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Media type:
E-Article
Title:
Probe‐based confocal laser endomicroscopy versus biopsies in the diagnostics of oesophageal and gastric lesions: A prospective, pathologist‐blinded study
Description:
<jats:sec><jats:title>Background and aim</jats:title><jats:p>Probe‐based confocal laser endomicroscopy (pCLE) provides real‐time microscopic visualisation. Our aim was to compare the diagnostic accuracy of pCLE with standard biopsies in patients with visible oesophageal or gastric lesions.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This was a single‐centre, prospective, pathologist‐blinded study. Patients underwent high‐resolution endoscopy, and lesions were examined by pCLE followed by standard biopsies. A definitive diagnosis was determined from resection specimen. Main outcomes were overall diagnostic accuracy, sensitivity, specificity and positive and negative predictive values.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We examined 74 lesions in 67 patients. Definitive diagnoses revealed 34 malignant and 40 non‐malignant lesions. pCLE diagnosis was correct in 89.2% (66/74), while diagnosis based on biopsy was correct in 85% (57/67; <jats:italic>p</jats:italic> = 0.6). The overall diagnostic accuracy of biopsies was 85% (76–94%) and that of pCLE was 89% (79–96%). pCLE correctly diagnosed malignant lesions, comprising oesophageal adenocarcinoma, oesophageal squamous‐cell cancer or gastric adenocarcinoma, in 88.2% (30/34) of cases, while biopsy was correctly diagnosed in 75.9% (22/29; <jats:italic>p</jats:italic> = 0.3). Sensitivity and specificity to diagnose a malignant lesion were 75.9% (95% confidence interval (CI) 56–89%) and 100% (95% CI 90–100%) for biopsies and 88.2% (95% CI 72–97%) and 92% (95% CI 79–98%) for pCLE. No differences between biopsies and pCLE were found with regard to sensitivity, specificity to diagnose dysplastic and benign lesions (<jats:italic>p</jats:italic> > 0.2).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>pCLE provides satisfactory diagnostic accuracy comparable with standard biopsies in patients with oesophageal or gastric lesions. ClinicalTrials.gov identifier: NCT0292049)</jats:p></jats:sec>