Department of Gastroenterology and Hepatology, University Hospital Maastricht, Maastricht, The Netherlands.
Clin Gastroenterol Hepatol. 2010 Apr;8(4):371-8. doi: 10.1016/j.cgh.2009.08.006. Epub 2009 Aug 13.
BACKGROUND & AIMS: Colorectal cancer surveillance guidelines rely on clinicohistologic features of adenomas. Unfortunately, in common practice, recording of these features lacks precision and uniformity, which might hamper appropriate follow-up decisions. Confocal laser endomicroscopy (CLE) is a novel technology that allows real-time in vivo microscopy of the mucosa and provides accurate histopathology. The aims of this study were (1) to define and validate differential features of adenomatous and nonadenomatous colorectal polyps by chromoendoscopy-guided CLE (C-CLE) and (2) to assess predictive value of this technique for diagnosis of colorectal neoplasia.
Patients at risk for colorectal cancer were prospectively investigated by using CLE. During extubation, fluorescein 10% was used in conjunction with acriflavine hydrochloride 0.05% to characterize global tissue architecture as well as cytonuclear features of colorectal epithelium. Ex vivo histology was used as gold standard. Reproducibility tests were performed.
In total, 116 colorectal polyps from 72 patients were examined. Ex vivo histology showed 68 adenomas, 6 invasive carcinomas, 30 hyperplastic polyps, and 12 inflammatory polyps. C-CLE of adenomas revealed lack of epithelial surface maturation, crypt budding, altered vascular pattern, and loss of cell polarity. In contrast, C-CLE of nonadenomatous polyps revealed epithelial surface maturation, and minor abnormalities of crypt architecture and of vascular pattern, and maintained cell polarity. Adenoma dysplasia score reliably discriminated high-grade dysplasia from low-grade dysplasia (accuracy, 96.7%). Interobserver agreement was high (K coefficients: pathologist, 0.92; endomicroscopist, 0.88). In vivo histology predicted ex vivo data with sensitivity of 97.3%, specificity of 92.8%, and accuracy of 95.7%.
C-CLE accurately discriminates adenomatous from nonadenomatous colorectal polyps and enables evaluation of degree of dysplasia during ongoing endoscopy. This technology might offer considerable potential to ultimately fine-tune surveillance programs, particularly in high-risk groups.
结直肠癌监测指南依赖于腺瘤的临床组织学特征。不幸的是，在常规实践中，这些特征的记录缺乏精确性和一致性，这可能会妨碍适当的随访决策。共聚焦激光内镜检查（CLE）是一种新型技术，可实时对粘膜进行体内显微镜检查，并提供准确的组织病理学。本研究的目的是（1）通过色素内镜引导 CLE（C-CLE）定义和验证腺瘤性和非腺瘤性结直肠息肉的差异特征，以及（2）评估该技术对结直肠肿瘤诊断的预测价值。
前瞻性地对有结直肠癌风险的患者进行 CLE 检查。在拔管过程中，使用 10%荧光素结合 0.05%吖啶黄盐酸盐对全球组织结构以及结直肠上皮的核质特征进行染色。将离体组织学作为金标准。进行了重复性测试。
共检查了 72 例患者的 116 个结直肠息肉。离体组织学显示 68 个腺瘤、6 个浸润性癌、30 个增生性息肉和 12 个炎性息肉。腺瘤的 C-CLE 显示上皮表面成熟缺失、隐窝芽生、血管模式改变和细胞极性丧失。相反，非腺瘤性息肉的 C-CLE 显示上皮表面成熟，隐窝结构和血管模式的轻微异常，并保持细胞极性。腺瘤异型增生评分可靠地区分高级别异型增生和低级别异型增生（准确性 96.7%）。观察者间的一致性很高（病理学家，0.92；内镜医生，0.88）。体内组织学预测离体数据的敏感性为 97.3%，特异性为 92.8%，准确性为 95.7%。
C-CLE 可准确区分结直肠的腺瘤性和非腺瘤性息肉，并能在进行内镜检查时评估异型增生的程度。该技术可能具有相当大的潜力，特别是在高危人群中，最终可以优化监测方案。
