Endoscopy Unit, Paoli-Calmettes Institute, 13400, Marseille, France.
Dig Dis Sci. 2013 Jun;58(6):1784-9. doi: 10.1007/s10620-012-2533-5. Epub 2013 Jan 12.
Most modalities for tissue confirmation during endoscopic retrograde cholangiopancreatography (ERCP) suffer from low sensitivity and poor diagnostic accuracy. Probe-based confocal laser endomicroscopy (pCLE) was prospectively evaluated in a multicenter registry including 102 patients with indeterminate strictures and demonstrated excellent sensitivity (98 %). Yet, several false-positive cases were induced by benign inflammatory conditions resulting in a specificity of 67 %.
To evaluate the diagnostic performance of pCLE for the diagnosis of indeterminate biliary stricture; and to propose interpretation criteria for benign inflammatory conditions to reduce the number of false positives.
Sixty cases from the prospective registry were reviewed retrospectively (27 malignant, 33 benign) by a panel of three biliary endoscopists. Each case's clinical history, ERCP impression, and corresponding pCLE sequences was used to score image quality, propose presumptive diagnoses, and rate level of diagnostic confidence.
Using the Miami Classification (MC), the overall accuracy in retrospectively diagnosing malignancy in those 60 cases was 85 versus 78 % for the prospective analysis, reducing the number of false positives from 12 to 8. A second review of the false-positive cases' pCLE sequences (benign inflammatory) helped refine the existing classification by identifying four descriptive criteria specific to benign inflammatory conditions (Paris Classification): Vascular congestion, dark granular patterns with scales, increased inter-glandular space, and thickened reticular structure.
The Paris Classification is a refinement of the existing Miami Classification to improve the accuracy of pCLE for diagnosing benign inflammatory strictures. Prospective multicenter studies are needed to further validate this refined classification criteria.
大多数在经内镜逆行胰胆管造影术（ERCP）期间进行组织确认的方式都存在敏感性低和诊断准确性差的问题。基于探头的共聚焦激光内窥镜检查（pCLE）在一个包括 102 例不确定狭窄的多中心登记处进行了前瞻性评估，其敏感性达到了 98%，表现出优异的性能。然而，由于良性炎症导致的假阳性病例较多，特异性仅为 67%。
评估 pCLE 对不确定胆管狭窄的诊断性能，并提出良性炎症情况的解释标准，以减少假阳性病例的数量。
回顾性分析前瞻性登记处的 60 例病例（27 例恶性，33 例良性），由三位胆道内镜医生组成的专家组进行分析。每位患者的临床病史、ERCP 印象和相应的 pCLE 序列都被用于评分图像质量、提出推测诊断，并评估诊断信心的水平。
使用迈阿密分类（MC），在这 60 例病例中，对恶性肿瘤的总体回顾性诊断准确率为 85%，而前瞻性分析为 78%，从而将假阳性病例的数量从 12 例减少到 8 例。对假阳性病例的 pCLE 序列（良性炎症）进行第二次审查有助于通过确定与良性炎症相关的四个具体描述性标准（巴黎分类）来改进现有的分类：血管充血、有鳞片的暗颗粒模式、腺体间空间增加和网状结构增厚。
巴黎分类是对现有的迈阿密分类的一种改进，可提高 pCLE 诊断良性炎症性狭窄的准确性。需要进行前瞻性多中心研究来进一步验证这种改进的分类标准。
