Clinical Trials Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2015; 21(22): 6974-6981
Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.6974
Detection of superficial esophageal squamous cell neoplasia by chromoendoscopy-guided confocal laser endomicroscopy
Jin Huang, Yun-Sheng Yang, Zhong-Sheng Lu, Shuang-Fang Wang, Jing Yang, Jing Yuan
Jin Huang, Department of Gastroenterology and Hepatology, Chinese PLA 153 Hospital, Zhengzhou 450000, Henan Province, China
Yun-Sheng Yang, Zhong-Sheng Lu, Shuang-Fang Wang, Jing Yang, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
Jing Yuan, Department of Pathology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Huang J and Yang YS designed the research; Huang J, Lu ZS, Wang SF and Yang J performed the research; Yuan J was responsible for the histological analysis; Huang J and Lu ZS analyzed the data; and Huang J wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yun-Sheng Yang, Professor, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, No. 28 Fuxing Road, 100853 Beijing, China. huangjin034@163.com
Telephone: +86-10-55499005 Fax: +86-10-55499005
Received: September 20, 2014
Peer-review started: September 21, 2014
First decision: October 19, 2014
Revised: December 3, 2014
Accepted: January 21, 2015
Article in press: January 21, 2015
Published online: June 14, 2015
Abstract

AIM: To evaluate the diagnostic potential of Lugol’s chromoendoscopy-guided confocal laser endomicroscopy (CLE) in detecting superficial esophageal squamous cell neoplasia (ESCN).

METHODS: Between December 2008 and September 2010, a total of 52 patients were enrolled at the Chinese PLA General Hospital in Beijing, China. First, Lugol’s chromoendoscopy-guided CLE was performed in these patients and the CLE in vivo histological diagnosis was recorded. Then, chromoendoscopy-guided biopsy was performed in the same patients by another endoscopist who was blinded to the CLE findings. Based on the biopsy and CLE diagnosis, en bloc endoscopic resection was performed. The CLE in vivo diagnosis and the histological diagnosis of biopsy of ESCN were compared, using a histological examination of the endoscopic resection specimens as the standard reference.

RESULTS: A total of 152 chromoendoscopy-guided biopsies were obtained from 56 lesions. In the 56 lesions of 52 patients, a total of 679 CLE images were obtained vs 152 corresponding biopsies. The sensitivity, specificity, negative predictive value and positive predictive value of chromoendoscopy-guided CLE compared with biopsy were 95.7% vs 82% (P < 0.05), 90% vs 70% (P < 0.05), 81.8% vs 46.7% (P < 0.05), and 97.8% vs 92.7% (P > 0.05), respectively. There was a significant improvement in sensitivity, specificity, negative predictive value, and accuracy when comparing chromoendoscopy-guided CLE with biopsy.

CONCLUSION: Lugol’s chromoendoscopy-guided CLE is a real-time, non-invasive endoscopic diagnostic technology; the accuracy of the detection of superficial ESCN is equivalent to or may be superior to biopsy histology.

Keywords: Superficial esophageal neoplasia, Squamous cell neoplasm, Confocal endomicroscopy, Endoscopic submucosal dissection, Chromoendoscopy

Core tip: The aim of the present study was to determine the diagnostic potential of confocal laser endomicroscopy (CLE) combined with Lugol’s iodine chromoendoscopy in detecting superficial esophageal squamous cell neoplasia (ESCN). Lugol’s chromoendoscopy-guided CLE was performed in 52 enrolled patients. In the same patients, chromoendoscopy-guided biopsy was performed by another endoscopist. A comparison of the detection rates between the CLE finding and biopsy was performed. The sensitivity, specificity, negative predictive value and positive predictive value of chromoendoscopy-guided CLE were 95.7%, 90%, 81.8% and 97.8%, respectively. There was a statistically significant difference in the detection of dysplasia between chromoendoscopy-guided CLE and biopsy. Lugol’s chromoendoscopy-guided CLE is a real-time, non-invasive endoscopic diagnostic technology; the accuracy of the detection of superficial ESCN is equivalent to or may be superior to biopsy histology.