共聚焦激光显微内镜在诊断不明的胃肠道病变管理中的临床影响。
Clinical impact of confocal laser endomicroscopy in the management of gastrointestinal lesions with an uncertain diagnosis.
作者信息
Robles-Medranda Carlos, Vargas Maria, Ospina Jesenia, Puga-Tejada Miguel, Valero Manuel, Soria Miguel, Bravo Gladys, Robles-Jara Carlos, Lukashok Hannah Pitanga
机构信息
Carlos Robles-Medranda, Maria Vargas, Jesenia Ospina, Miguel Puga-Tejada, Manuel Valero, Miguel Soria, Gladys Bravo, Carlos Robles-Jara, Hannah Pitanga Lukashok, Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital OMNI, Guayaquil 090505, Ecuador.
出版信息
World J Gastrointest Endosc. 2017 Aug 16;9(8):389-395. doi: 10.4253/wjge.v9.i8.389.
AIM
To evaluate the clinical impact of confocal laser endomicroscopy (CLE) in the diagnosis and management of patients with an uncertain diagnosis.
METHODS
A retrospective chart review was performed. Patients who underwent CLE between November 2013 and October 2015 and exhibited a poor correlation between endoscopic and histological findings were included. Baseline characteristics, indications, previous diagnostic studies, findings at the time of CLE, clinical management and histological results were analyzed. Interventions based on CLE findings were also analyzed. We compared the diagnostic accuracy of CLE and target biopsies of surgical specimens.
RESULTS
A total of 144 patients were included. Of these, 51% (74/144) were female. The mean age was 51 years old. In all, 41/144 (28.4%) lesions were neoplastic (13 bile duct, 10 gastric, 8 esophageal, 6 colonic, 1 duodenal, 1 rectal, 1 ampulloma and 1 pancreatic). The sensitivity, specificity, positive predictive value, negative predictive value, and observed agreement when CLE was used to detect N-lesions were 85.37%, 87.38%, 72.92%, 93.75% and 86.81%, respectively. Cohen's Kappa was 69.20%, thus indicating good agreement. Changes in management were observed in 54% of the cases.
CONCLUSION
CLE is a new diagnostic tool that has a significant clinical impact on the diagnosis and treatment of patients with uncertain diagnosis.
目的
评估共聚焦激光显微内镜检查（CLE）在诊断不明确患者的诊断和管理中的临床影响。
方法
进行回顾性病历审查。纳入2013年11月至2015年10月期间接受CLE检查且内镜检查结果与组织学检查结果相关性较差的患者。分析基线特征、适应证、先前的诊断研究、CLE检查时的结果、临床管理和组织学结果。还分析了基于CLE检查结果的干预措施。我们比较了CLE和手术标本靶向活检的诊断准确性。
结果
共纳入144例患者。其中，51%（74/144）为女性。平均年龄为51岁。总共41/144（28.4%）个病变为肿瘤性病变（13个胆管、10个胃、8个食管、6个结肠、1个十二指肠、1个直肠、1个壶腹瘤和1个胰腺）。当使用CLE检测N病变时，其敏感性、特异性、阳性预测值、阴性预测值和观察一致性分别为85.37%、87.38%、72.92%、93.75%和86.81%。Cohen's Kappa为69.20%，表明一致性良好。54%的病例观察到管理方式的改变。
结论
CLE是一种新的诊断工具，对诊断不明确的患者的诊断和治疗具有显著的临床影响。
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