Pang Suya, Yao Hailing, Jiang Chen, Zhang Qin, Lin Rong
Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Oncol. 2022 Mar 24;12:809822. doi: 10.3389/fonc.2022.809822. eCollection 2022.
Chronic atrophic gastritis (CAG) is closely related to the development of gastric cancer. However, the diagnostic accuracy of white light endoscopy (WLE) biopsy for CAG is poor. The diagnostic role and efficacy of confocal laser endomicroscopy (CLE) in CAG missed under WLE biopsy remain unclear.
This study is a single-center prospective study that included 21 patients from 1,349 patients who underwent WLE and biopsy and whose WLE results confirmed CAG, but pathological results did not. Then, all these patients received CLE examination and underwent targeted biopsies and five-point standard biopsies. The sensitivity, specificity, and accuracy of CLE diagnosis and targeted biopsy were analyzed.
The pathological results of five-point standard biopsies in 21 patients confirmed CAG, and 17 patients (81.0%) were confirmed to have intestinal metaplasia (IM). According to the image diagnosis of CLE, there were 19 cases (90.5%) of CAG and 14 cases (66.7%) of IM among these 21 patients. According to the targeted biopsy of CLE, 17 cases (81.0%) of CAG and 14 cases (66.7%) of IM were diagnosed. There was no significant difference between CLE image diagnosis and five-point standard biopsies in terms of atrophy severity score (p = 0.927), IM severity score (p = 0.250), atrophy scope score (p = 0.781), and IM scope score (p = 0.195). For CAG, the sensitivity and accuracy of CLE image diagnosis were higher than those of CLE targeted biopsies (90.5% vs. 81.0%, p = 0.331), but for IM, the diagnosis was the same.
CLE can improve the diagnosis rate of CAG and can increase the comprehensive assessment of the scope and severity of CAG.
慢性萎缩性胃炎（CAG）与胃癌的发生密切相关。然而，白光内镜（WLE）活检对CAG的诊断准确性较差。共聚焦激光显微内镜（CLE）在WLE活检漏诊的CAG中的诊断作用及效能尚不清楚。
本研究为单中心前瞻性研究，从1349例行WLE及活检且WLE结果确诊为CAG但病理结果未确诊的患者中纳入21例患者。然后，所有这些患者接受CLE检查，并进行靶向活检和五点标准活检。分析CLE诊断及靶向活检的敏感性、特异性和准确性。
21例患者的五点标准活检病理结果确诊为CAG，17例（81.0%）确诊为肠化生（IM）。根据CLE的图像诊断，这21例患者中有19例（90.5%）为CAG，14例（66.7%）为IM。根据CLE的靶向活检，诊断出17例（81.0%）CAG和14例（66.7%）IM。CLE图像诊断与五点标准活检在萎缩严重程度评分（p = 0.927）、IM严重程度评分（p = 0.250）、萎缩范围评分（p = 0.781）和IM范围评分（p = 0.195）方面无显著差异。对于CAG，CLE图像诊断的敏感性和准确性高于CLE靶向活检（90.5%对81.0%，p = 0.331），但对于IM，诊断相同。
CLE可提高CAG的诊断率，并可增加对CAG范围和严重程度的综合评估。
