Department of Gastroenterology and Hepatology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
Department of Biochemistry, Bilawal Medical College, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
Asian Pac J Cancer Prev. 2023 Jun 1;24(6):1949-1954. doi: 10.31557/APJCP.2023.24.6.1949.
Upper gastrointestinal malignancies are a major global health burden. Early diagnosis of upper gastrointestinal premalignant and malignant lesions is crucial for improving prognosis and reducing morbidity and mortality. The purpose of this study was to investigate the diagnostic accuracy of confocal laser endomicroscopy (CLE) in detecting upper gastrointestinal premalignant and early malignant lesions in high-risk patients, as well as diagnosing patients with inconclusive white light endoscopy (WLE) and histopathology results.
It was a cross-sectional study that included ninety (n = 90) high-risk patients with inconclusive diagnoses of upper gastrointestinal lesions on WLE and WLE-based biopsy histopathology. These patients underwent CLE, and the definitive diagnosis was confirmed using CLE and CLE-target biopsy histopathology. Diagnostic accuracy was determined by comparing the sensitivity, specificity, predictive values, and accuracy between the procedures.
The mean patient age was 47.43 ± 11.18 years. CLE and target biopsy confirmed that 30 (33.3%) patients had normal histology, while 60 (66.7%) patients were diagnosed with gastritis, gastric intestinal metaplasia, high-grade dysplasia, adenocarcinoma, Barrett's esophagus, and squamous cell carcinoma of the esophagus. The results of CLE were superior to those of WLE in terms of diagnostic parameters. Additionally, CLE demonstrated nearly similar results in sensitivity (98.33%), specificity (100%), positive predictive value (100%), negative predictive value (96.77%), and accuracy (98.89%) when compared to CLE-target biopsy.
CLE showed higher diagnostic accuracy in differentiating normal, premalignant and malignant lesions. It effectively diagnosed patients who initially had inconclusive WLE and/or biopsy results. Furthermore, early detection of upper gastrointestinal premalignant or malignant lesions may improve prognosis and reduce morbidity and mortality.
上消化道恶性肿瘤是全球重大健康负担。早期诊断上消化道癌前病变和恶性病变对于改善预后、降低发病率和死亡率至关重要。本研究旨在探讨共聚焦激光内镜（CLE）诊断高危人群上消化道癌前病变和早期恶性病变的准确性，以及对白光内镜（WLE）和 WLE 下活检组织学结果不确定患者的诊断价值。
这是一项横断面研究，纳入 90 例 WLE 及 WLE 下活检组织学结果不确定的上消化道病变高危患者。这些患者接受 CLE 检查，采用 CLE 和 CLE 靶向活检组织学检查明确诊断。通过比较两种方法的灵敏度、特异度、预测值和准确率来评估诊断准确性。
患者平均年龄为 47.43 ± 11.18 岁。CLE 和靶向活检均证实 30 例（33.3%）患者组织学正常，而 60 例（66.7%）患者诊断为胃炎、胃肠化生、高级别上皮内瘤变、腺癌、Barrett 食管和食管鳞状细胞癌。与 WLE 相比，CLE 的诊断参数更优。此外，CLE 的灵敏度（98.33%）、特异度（100%）、阳性预测值（100%）、阴性预测值（96.77%）和准确率（98.89%）与 CLE 靶向活检相近。
CLE 在上消化道正常、癌前病变和恶性病变的鉴别诊断中具有更高的准确性。它可以有效诊断初始 WLE 和/或活检结果不确定的患者。此外，早期发现上消化道癌前病变或恶性病变可能改善预后、降低发病率和死亡率。
