Chen Qian, Cheng Heng-Hui, Deng Shuang, Kuang Dong, Shu Chang, Cao Li, Liao Guang-Quan, Guo Qiao-Zhen, Zhou Qi
Endoscopic Unit, Department of Gastroenterology and Hepatology at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.
Department of Pathology at Tongji Hospital, Tongji Medical College, HUST, Wuhan, China.
Gastroenterol Res Pract. 2018 Jun 13;2018:5073182. doi: 10.1155/2018/5073182. eCollection 2018.
To evaluate the performance of probe-based confocal laser endomicroscopy (pCLE) in diagnosis of gastric lesions.
An outpatient department- (OPD-) based retrospective study was conducted for patients with suspected upper gastrointestinal (GI) tract lesions who underwent pCLE between 2014 and 2016 at a tertiary hospital in China. Final diagnosis was based on the histopathological reports. CLE reports were compared to histopathological reports to evaluate the diagnostic ability, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy.
322 of 380 patients were diagnosed with gastric lesions via pCLE, including inflammation and benign ulcers ( = 110), atrophy and intestinal metaplasia ( = 152), intraepithelial neoplasia ( = 27), adenocarcinoma ( = 27), and lymphoma ( = 6). In total, the diagnostic ability of CLE in evaluation of gastric lesions showed sensitivity 72.4% (95% confidence interval (CI): 67.1-77.2%); specificity 93.1% (95% CI: 5.6-8.4%); PPV 72.4% (95% CI: 67.1-77.2%); NPV 93.1% (95% CI: 5.6-8.4%); and accuracy 88.9% (95% CI: 87.3-90.4%), respectively. We further observed the capability of pCLE in diagnosing six gastric lymphoma showing those affected mucosa densely infiltrated with identical and round-shaped abnormal cells. Immunohistochemistry analysis confirmed one patient with diffuse large B-cell non-Hodgkin's lymphoma (DLBCL) and five with mucosa-associated lymphoid tissue (MALT) lymphoma.
pCLE is an accurate tool for the detection of gastric lesions and shows optimal values of sensitivity and negative predictivity. Moreover, combining pCLE with white light endoscopy (WLE) may be a promising adjunct to conventional biopsy sampling in evaluating GI tract with suspected lymphoma.
评估基于探头的共聚焦激光内镜显微镜（pCLE）在胃病变诊断中的性能。
对2014年至2016年在中国一家三级医院接受pCLE检查的疑似上消化道（GI）道病变患者进行了一项基于门诊（OPD）的回顾性研究。最终诊断基于组织病理学报告。将CLE报告与组织病理学报告进行比较，以评估诊断能力，包括敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性。
380例患者中有322例通过pCLE诊断为胃病变，包括炎症和良性溃疡（=110）、萎缩和肠化生（=152）、上皮内瘤变（=27）、腺癌（=27）和淋巴瘤（=6）。总体而言，CLE评估胃病变的诊断能力显示敏感性为72.4%（95%置信区间（CI）：67.1 - 77.2%）；特异性为93.1%（95%CI：5.6 - 8.4%）；PPV为72.4%（95%CI：67.1 - 77.2%）；NPV为93.1%（95%CI：5.6 - 8.4%）；准确性为88.9%（95%CI：87.3 - 90.4%）。我们进一步观察了pCLE诊断6例胃淋巴瘤的能力，显示受影响的黏膜密集浸润着相同的圆形异常细胞。免疫组织化学分析证实1例为弥漫性大B细胞非霍奇金淋巴瘤（DLBCL），5例为黏膜相关淋巴组织（MALT）淋巴瘤。
pCLE是检测胃病变的准确工具，显示出最佳的敏感性和阴性预测值。此外，将pCLE与白光内镜检查（WLE）相结合可能是在评估疑似淋巴瘤的胃肠道时传统活检采样的一种有前景的辅助手段。
