Guo Jing, Li Chang-Qing, Li Ming, Zuo Xiu-Li, Yu Tao, Liu Jian-Wei, Liu Jing, Kou Guan-Jun, Li Yan-Qing
Department of Gastroenterology, Translational Gastroenterology Laboratory, Shandong University Qilu Hospital, Jinan, Shandong, China.
Gastrointest Endosc. 2015;81(6):1346-54. doi: 10.1016/j.gie.2014.10.041. Epub 2015 Feb 10.
Detection and differentiation of esophageal squamous neoplasia (ESN) are of value in improving patient outcomes. Probe-based confocal laser endomicroscopy (pCLE) can serve in targeted biopsies in the diagnosis of GI neoplasia. However, its performance in ESN has not yet been reported.
To investigate the diagnostic value of pCLE for early ESN screened by high-definition virtual chromoendoscopy (I-Scan) and verified by Lugol chromoendoscopy and histopathology.
Prospective and noninferiority trial.
Single center in China.
Patients were enrolled who (1) previously had histologically verified early ESN or (2) were about to undergo screening endoscopy and were 50 to 80 years of age between February 2013 and February 2014.
The esophagus was investigated sequentially by white-light endoscopy, I-Scan, then pCLE and iodine chromoendoscopy. The results were interpreted and compared with histopathologic results.
Diagnostic characteristics of pCLE and I-Scan.
In total, 356 patients were enrolled. In all, 42 patients were histologically proven to have 47 neoplasias. The diagnostic value of pCLE for ESN during ongoing endoscopy has a sensitivity, specificity, and accuracy of 94.6%, 90.7%, and 92.3%, respectively. The interobserver and intraobserver agreement was good and excellent, with κ values of 0.699 and 0.895, respectively. The detection rate by using I-Scan and Lugol chromoendoscopy was 10.4% and 12.9%, respectively (P<.01 for noninferiority).
Single center.
pCLE shows promise in diagnosing and differentiating ESN in vivo. The screening performance of I-Scan in the detection of ESN is noninferior to that of iodine chromoendoscopy.
食管鳞状上皮瘤变（ESN）的检测与鉴别对于改善患者预后具有重要意义。基于探头的共聚焦激光内镜检查（pCLE）可用于胃肠道肿瘤诊断中的靶向活检。然而，其在ESN中的表现尚未见报道。
探讨pCLE对经高清虚拟色素内镜检查（I-Scan）筛查并经卢戈氏色素内镜检查及组织病理学证实的早期ESN的诊断价值。
前瞻性非劣效性试验。
中国的单中心。
纳入的患者为（1）既往经组织学证实为早期ESN者或（2）2013年2月至2014年2月期间即将接受筛查内镜检查且年龄在50至80岁之间者。
依次通过白光内镜、I-Scan、pCLE及碘染色内镜对食管进行检查。对结果进行解读并与组织病理学结果进行比较。
pCLE和I-Scan的诊断特征。
共纳入356例患者。其中，42例患者经组织学证实患有47处瘤变。pCLE在实时内镜检查中对ESN的诊断价值的敏感性、特异性和准确性分别为94.6%、90.7%和92.3%。观察者间及观察者内一致性良好及优秀，κ值分别为0.699和0.895。使用I-Scan和卢戈氏色素内镜检查的检出率分别为10.4%和12.9%（非劣效性P<0.01）。
单中心研究。
pCLE在体内诊断和鉴别ESN方面显示出前景。I-Scan在ESN检测中的筛查性能不劣于碘染色内镜。
