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Cho H, Moon D, Heo SM, Chu J, Bae H, Choi S, Lee Y, Kim D, Jo Y, Kim K, Hwang K, Lee D, Choi HK, Kim S. Artificial intelligence-based real-time histopathology of gastric cancer using confocal laser endomicroscopy. NPJ Precis Oncol 2024; 8:131. [PMID: 38877301 PMCID: PMC11178780 DOI: 10.1038/s41698-024-00621-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/24/2024] [Indexed: 06/16/2024] Open
Abstract
There has been a persistent demand for an innovative modality in real-time histologic imaging, distinct from the conventional frozen section technique. We developed an artificial intelligence-driven real-time evaluation model for gastric cancer tissue using confocal laser endomicroscopic system. The remarkable performance of the model suggests its potential utilization as a standalone modality for instantaneous histologic assessment and as a complementary tool for pathologists' interpretation.
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Affiliation(s)
- Haeyon Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Damin Moon
- Artificial Intelligence Research Center, JLK Inc., Seoul, Republic of Korea
| | - So Mi Heo
- Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jinah Chu
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyunsik Bae
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Pathology center, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Sangjoon Choi
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yubin Lee
- Artificial Intelligence Research Center, JLK Inc., Seoul, Republic of Korea
| | - Dongmin Kim
- Artificial Intelligence Research Center, JLK Inc., Seoul, Republic of Korea
| | - Yeonju Jo
- VPIX Medical Inc., Daejeon, Republic of Korea
| | | | | | - Dakeun Lee
- Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea.
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea.
| | - Heung-Kook Choi
- Artificial Intelligence Research Center, JLK Inc., Seoul, Republic of Korea.
| | - Seokhwi Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea.
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea.
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Seerani NL, Laghari H, Khidri FF, Sawai S, Bajwa A, Devi J. Role of Confocal Laser Endomicroscopy in Early Detection of Upper Gastrointestinal Malignancy in High Risk Patients. Asian Pac J Cancer Prev 2023; 24:1949-1954. [PMID: 37378923 PMCID: PMC10505884 DOI: 10.31557/apjcp.2023.24.6.1949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/23/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND 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. METHODS 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. RESULT 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. CONCLUSION 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.
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Affiliation(s)
- Nand Lal Seerani
- Department of Gastroenterology and Hepatology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
| | - Hira Laghari
- Department of Gastroenterology and Hepatology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
| | - Feriha Fatima Khidri
- Department of Biochemistry, Bilawal Medical College, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
- Department of Molecular Biology and Genetics, Medical Research Centre, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
| | - Sajan Sawai
- Department of Gastroenterology, Indus Medical College and Hospital, Tando Mohammad Khan, Pakistan.
| | - Akram Bajwa
- Department of Gastroenterology and Hepatology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
| | - Jalpa Devi
- Department of Gastroenterology and Hepatology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
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Han W, Kong R, Wang N, Bao W, Mao X, Lu J. Confocal Laser Endomicroscopy for Detection of Early Upper Gastrointestinal Cancer. Cancers (Basel) 2023; 15:cancers15030776. [PMID: 36765734 PMCID: PMC9913498 DOI: 10.3390/cancers15030776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
Esophageal and gastric cancers are common diseases with high morbidity and mortality; thus, early detection and treatment are beneficial to improve prognosis. Confocal laser endomicroscopy (CLE) is a novel imaging technique that permits the histological analysis of tissues during endoscopy. CLE has been shown to uniquely affect the diagnosis of early upper gastrointestinal cancers. Relevant literature was searched using PubMed and Google Scholar databases. Despite inherent flaws, CLE can reduce tissue damage and improve diagnostic accuracy to a certain extent. CLE in combination with other imaging methods can help enhance the detection rate and avoid unnecessary biopsies in the management of esophageal or gastric cancer and precancerous lesions. CLE is of great significance in the diagnosis and surveillance of early cancers of the upper gastrointestinal tract. Further technical innovations and the standardisation of CLE will make it more responsive to the needs of routine clinical applications.
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Affiliation(s)
- Wei Han
- Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Rui Kong
- Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Nan Wang
- Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Wen Bao
- Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xinli Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang 317099, China
- Correspondence: (X.M.); (J.L.)
| | - Jie Lu
- Department of Gastroenterology, Gongli Hospital of Shanghai Pudong New Area, Shanghai 200135, China
- Correspondence: (X.M.); (J.L.)
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Zhou YW, Zhang LY, Ding SN, Zhang AL, Zhu Y, Chen YX, Zhang QC, Sun LT, Yu JR. Hesitate between confocal laser endomicroscopy and narrow-band imaging: how to choose a better method in the detection of focal precancerous state of gastric cancer. Am J Transl Res 2022; 14:55-67. [PMID: 35173829 PMCID: PMC8829604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/14/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND With a high incidence globally, deaths form gastric cancer (GC) are not rare. Early diagnosis is crucial to ameliorate its prognosis. Confocal laser endomicroscopy (CLE) and narrow band imaging (NBI) have been extensively applied in gastroscopy, particularly when it comes to the detection and management of premalignant gastric lesion. Our meta-analysis intends to appraise the diagnostic capability and compare the efficacy of NBI and CLE for focal precancerous state of gastric cancer. METHODS We performed a literature search up to November 5, 2020 in online databases and major conferences. Two investigators assessed the methodological bias by QUADAS-2, followed by sophisticated study selection and data exaction to make a comparison between sensitivity, specificity, positive and negative likelihood values, and diagnostic odds ratio. A symmetric summary receiver-operating curve (sROC) and its area under the curve (AUC) were used to estimate threshold effect. Additionally, we evaluated the publication bias by Deeks' asymmetry test. RESULTS AND CONCLUSIONS Four studies involved 248 patients and 526 lesions. In analysis drawn from every lesion, the NBI's pooled sensitivity and specificity were 87% (95% CI: 0.80-0.92) and 85% (95% CI: 0.75-0.91), and those of CLE were 90% (95% CI: 0.85-0.91) and 87% (95% CI: 0.83-0.91). CLE illustrated that the pooled two were slightly higher than NBI when compared at the level of every lesion. The AUC for NBI and CLE was 0.92 (0.90-0.94) and 0.95 (0.92-0.96), and there might be a threshold effect, according to the shoulder-like distribution of scatter points in the sROC. We did not find obvious publication bias in our meta-analysis.
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Affiliation(s)
- Yi-Wen Zhou
- The Second School of Clinical Medicine, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, China
| | - Le-Yin Zhang
- Department of Oncology, Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine)Hangzhou 310007, Zhejiang, China
| | - Shu-Ning Ding
- The First School of Clinical Medicine, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, China
| | - An-Lai Zhang
- The First School of Clinical Medicine, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, China
| | - Ying Zhu
- The First School of Clinical Medicine, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, China
| | - Yu-Xuan Chen
- The First School of Clinical Medicine, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, China
| | - Qi-Chen Zhang
- The First School of Clinical Medicine, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, China
| | - Lei-Tao Sun
- Department of Medical Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine)Hangzhou 310006, Zhejiang, China
| | - Jie-Ru Yu
- School of Basic Medical Sciences, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, China
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Zhou J, Wu H, Fan C, Chen S, Liu A. Comparison of the diagnostic efficacy of blue laser imaging with narrow band imaging for gastric cancer and precancerous lesions: a meta-analysis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:649-658. [PMID: 32686455 DOI: 10.17235/reed.2020.6591/2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS novel endoscopic techniques including narrowband imaging (NBI) and blue laser imaging (BLI) have led to the improved detection of early stage gastric cancer and precancerous lesions. However, these techniques are not generally thought to be equivalent at present and BLI is generally considered as superior to NBI. Therefore, this comprehensive meta-analysis aimed to definitively compare the diagnostic efficacy of NBI and BLI for the diagnosis of gastric cancer and precancerous lesions. METHODS relevant articles were identified via searches of the PubMed, Web of Science, Embase and Cochrane Library databases from their inception until October 2019. In total, 28 relevant studies were identified and incorporated into the meta-analysis. RevMan5.3 was used to assess the relative diagnostic efficacy of these two imaging modalities in these studies. The threshold was assessed using Meta-DiSc 1.4 and STATA 14.0 for bivariate regression modeling of pooled studies. RESULTS the pooled sensitivity of BLI for gastric cancer was 0.89 (0.80, 0.95) and the specificity was 0.92 (0.76, 0.98). The pooled sensitivity of NBI for gastric cancer was 0.83 (0.75, 0.89) and the specificity was 0.95 (0.91, 0.97). The pooled sensitivity of BLI for precancerous lesions was 0.81 (0.71, 0.87) and the specificity was 0.90 (0.80, 0.96). The pooled sensitivity of NBI for precancerous lesions was 0.80 (0.75, 0.85) and the specificity was 0.88 (0.77, 0.94). CONCLUSIONS this study showed that both BLI and NBI have a very high diagnostic efficacy for the detection of gastric cancer and precancerous lesions, the sensitivity and specificity of these two approaches were similar.
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Affiliation(s)
- Jingyuan Zhou
- Endoscopy, Affiliated Tumor Hospital of Guangxi Medical University,
| | - Huijie Wu
- Endoscopy, Affiliated Tumor Hospital of Guangxi Medical University,
| | - Chenglong Fan
- Endoscopy, Affiliated Tumor Hospitalof Guangxi Medical University, Nanning,
| | - Songda Chen
- Endoscopy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning.,
| | - Aiqun Liu
- Endoscopy, Affiliated Tumor Hospital of Guangxi Medical Unive,
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Rodríguez-Carrasco M, Esposito G, Libânio D, Pimentel-Nunes P, Dinis-Ribeiro M. Image-enhanced endoscopy for gastric preneoplastic conditions and neoplastic lesions: a systematic review and meta-analysis. Endoscopy 2020; 52:1048-1065. [PMID: 32663879 DOI: 10.1055/a-1205-0570] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND : Image-enhanced endoscopy (IEE) improves the accuracy of endoscopic diagnosis. We aimed to assess the value of IEE for gastric preneoplastic conditions and neoplastic lesions. METHODS : Medline and Embase were searched until December 2018. Studies allowing calculation of diagnostic measures were included. Risk of bias and applicability were assessed using QUADAS-2. Subgroup analysis was performed to explore heterogeneity. RESULTS : 44 studies met the inclusion criteria. For gastric intestinal metaplasia (GIM), narrow-band imaging (NBI) obtained a pooled sensitivity and specificity of 0.79 (95 %CI 0.72-0.85) and 0.91 (95 %CI 0.88-0.94) on per-patient basis; on per-biopsy basis, it was 0.84 (95 %CI 0.81-0.86) and 0.95 (95 %CI 0.94-0.96), respectively. Tubulovillous pattern was the most accurate marker to detect GIM and it was effectively assessed without high magnification. For dysplasia, NBI showed a pooled sensitivity and specificity of 0.87 (95 %CI 0.84-0.89) and 0.97 (95 %CI 0.97-0.98) on per-biopsy basis. The use of magnification improved the performance of NBI to characterize early gastric cancer (EGC), especially when the vessel plus surface (VS) classification was applied. Regarding other technologies, trimodal imaging also obtained a high accuracy for dysplasia (sensitivity 0.93 [95 %CI 0.85-0.98], specificity 0.98 [95 %CI 0.92-1.00]). For atrophic gastritis, no specific pattern was noted and none of the technologies reached good diagnostic yield. CONCLUSION : NBI is highly accurate for GIM and dysplasia. The presence of tubulovillous pattern and the VS classification seem to be useful to detect GIM and characterize EGC, respectively. These features should be used in current practice and to standardize endoscopic criteria for other technologies.
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Affiliation(s)
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Diogo Libânio
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,MEDCIDS - Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,MEDCIDS - Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal.,Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,MEDCIDS - Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
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SAGES TAVAC safety and efficacy analysis confocal laser endomicroscopy. Surg Endosc 2020; 35:2091-2103. [PMID: 32405892 DOI: 10.1007/s00464-020-07607-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Confocal laser endomicroscopy (CLE) is a novel endoscopic adjunct that allows real-time in vivo histological examination of mucosal surfaces. By using intravenous or topical fluorescent agents, CLE highlights certain mucosal elements that facilitate an optical biopsy in real time. CLE technology has been used in different organ systems including the gastrointestinal tract. There has been numerous studies evaluating this technology in gastrointestinal endoscopy, our aim was to evaluate the safety, value, and efficacy of this technology in the gastrointestinal tract. METHODS The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Technology and Value Assessment Committee (TAVAC) performed a PubMed/Medline database search of clinical studies involving CLE in May of 2018. The literature search used combinations of the keywords: confocal laser endomicroscopy, pCLE, Cellvizio, in vivo microscopy, optical histology, advanced endoscopic imaging, and optical diagnosis. Bibliographies of key references were searched for relevant studies not covered by the PubMed search. Case reports and small case series were excluded. The manufacturer's website was also used to identify key references. The United States Food and Drug Administration (U.S. FDA) Manufacturer And User facility and Device Experience (MAUDE) database was searched for reports regarding the device malfunction or injuries. RESULTS The technology offers an excellent safety profile with rare adverse events related to the use of fluorescent agents. It has been shown to increase the detection of dysplastic Barrett's esophagus, gastric intraepithelial neoplasia/early gastric cancer, and dysplasia associated with inflammatory bowel disease when compared to standard screening protocols. It also aids in the differentiation and classification of colorectal polyps, indeterminate biliary strictures, and pancreatic cystic lesions. CONCLUSIONS CLE has an excellent safety profile. CLE can increase the diagnostic accuracy in a number of gastrointestinal pathologies.
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Nabi Z, Reddy DN. Optical biopsy in gastroenterology: Focus on confocal laser endomicroscopy. Indian J Gastroenterol 2019; 38:281-286. [PMID: 31578678 DOI: 10.1007/s12664-019-00986-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/26/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Zaheer Nabi
- Asian institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500 082, India
| | - D Nageshwar Reddy
- Asian institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500 082, India.
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Zhou F, Wu L, Huang M, Jin Q, Qin Y, Chen J. The accuracy of magnifying narrow band imaging (ME-NBI) in distinguishing between cancerous and noncancerous gastric lesions: A meta-analysis. Medicine (Baltimore) 2018; 97:e9780. [PMID: 29489678 PMCID: PMC5851730 DOI: 10.1097/md.0000000000009780] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous clinical trials have demonstrated the diagnostic accuracy of magnifying narrow-band (ME-NBI) for gastric cancerous lesions, but the results are inconsistent. The purpose of this meta-analysis is to investigate the accuracy of ME-NBI in distinguishing between cancerous and noncancerous gastric lesions. METHODS Systematic literature searches were conducted until October 2016 in PubMed, Embase by 2 independent reviewers. Meta-analysis was performed to calculate the pooled sensitivity, specificity. Two authors independently evaluated studies for inclusion, rated methodological quality, and abstracted relevant data. Meta-analytic method was used to construct summary receiver operating characteristic curves, and pooled sensitivity, specificity were calculated. RESULTS Nine studies enrolling 5398 lesions were included. The pooled sensitivity, specificity were 88% (95% confidence interval [CI]: 78-93%), 96% (95% CI: 91-98%), respectively. The area under the curve (AUC) was 0.97. There was a large heterogeneity between the included studies. Studies with lesions ≤ 10 mm still had a high pooled sensitivity of 81% (95% CI: 73-90%) and specificity of 97% (95% CI: 95-100%). Studies which analyzed resected specimens had a sensitivity of 91% (95 CI: 82-99%) and specificity of 88% (95% CI: 83-94%), and studies which analyzed biopsied specimens had a sensitivity of 85% (95 CI: 74-96%) and specificity of 99% (95% CI: 98-99%). CONCLUSIONS ME-NBI is highly accurate and consistent to distinguish between gastric cancerous and noncancerous lesions.
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Bang CS, Park JM, Baik GH, Park JJ, Joo MK, Jang JY, Jeon SW, Choi SC, Sung JK, Cho KB. Therapeutic Outcomes of Endoscopic Resection of Early Gastric Cancer with Undifferentiated-Type Histology: A Korean ESD Registry Database Analysis. Clin Endosc 2017; 50:569-577. [PMID: 28743132 PMCID: PMC5719916 DOI: 10.5946/ce.2017.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/23/2017] [Accepted: 03/06/2017] [Indexed: 02/06/2023] Open
Abstract
Background/Aims To assess the therapeutic outcomes of endoscopic resection (ER) of early gastric cancer (EGC) with undifferentiated-type histology.
Methods Cases of ER of EGC with undifferentiated-type histology in the Korean endoscopic submucosal dissection (ESD) registry database were identified and reviewed. The immediate outcomes, including en bloc resection, complete resection, and curative resection rates, and long-term outcomes, including recurrence and survival rates, were extracted and analyzed.
Results From 2006 to 2015, 275 EGCs with undifferentiated-type histology from 275 patients were identified. The immediate outcomes were as follows: en bloc resection rate: 92.4%; complete resection rate: 80%; and curative resection rate: 36.4%. Compared to patients with lesions that were beyond the expanded indication, those with expanded indication lesions showed better therapeutic outcomes. There was no difference in immediate outcomes between patients with poorly differentiated adenocarcinoma (PDC) and signet ring cell carcinoma (SRC). However, compared to ER of SRC, ER of PDC had a stronger association with submucosal invasion (41.9% vs. 23.6%, p=0.003). With regard to long-term outcomes, there was no difference between lesions with curative and non-curative resections in the recurrence and mortality rates. These rates also did not differ between PDC and SRC (median follow up: 3.96 years).
Conclusions ER confined to expanded indication lesions can be considered for treatment of EGC with undifferentiated-type histology.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jae Myung Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jong Jae Park
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Moon Kyung Joo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Young Jang
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Suck Chei Choi
- Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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Zhang HP, Yang S, Chen WH, Hu TT, Lin J. The diagnostic value of confocal laser endomicroscopy for gastric cancer and precancerous lesions among Asian population: a system review and meta-analysis. Scand J Gastroenterol 2017; 52:382-388. [PMID: 28078907 DOI: 10.1080/00365521.2016.1275770] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of this study is to evaluate the diagnostic value of confocal laser endomicroscopy (CLE) in detection of gastric cancer (GC), gastric intraepithelial metaplasia (GIM), and gastric intraepithelial neoplasia (GIN) lesions. METHOD PubMed, the Cochrane Library, and Wangfang databases were searched to include eligible articles about CLE in detection of gastric lesions. After study selection, quality assessment and data extraction conducted by two reviewers independently, meta-analysis was performed by Meta-Disc 1.4. The pooled sensitivity and specificity was calculated, receiver operating characteristic (ROC) curve was constructed, and the area under ROC curve (AUC) was calculated. RESULTS Twenty-three studies evaluating the diagnostic value of CLE were included. For the diagnosis of GC lesions, the pooled sensitivity, specificity, and AUC were 91% (88-94%), 99% (99-99%), and 0.9513, respectively. For the diagnosis of lesions, the pooled sensitivity, specificity, and AUC were 92% (90-94%), 97% (96-98%), and 0.9774, respectively. For the diagnosis of GIN lesions, the pooled sensitivity, specificity and AUC were 81% (75-85%), 98% (97-98%), and 0.9204, respectively. CONCLUSIONS CLE can provide an accurate diagnosis with high sensitivity and specificity for GC, GIM, and GIN lesions. The results should be confirmed by well-designed, multi-centered, randomized controlled, and double blinded trials with large samples.
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Affiliation(s)
- Hai-Ping Zhang
- a Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
| | - Sheng Yang
- a Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
| | - Wen-Hua Chen
- a Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
| | - Teng-Teng Hu
- a Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
| | - Jun Lin
- a Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
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He XK, Liu D, Sun LM. Diagnostic performance of confocal laser endomicroscopy for optical diagnosis of gastric intestinal metaplasia: a meta-analysis. BMC Gastroenterol 2016; 16:109. [PMID: 27596838 PMCID: PMC5011919 DOI: 10.1186/s12876-016-0515-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 08/10/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gastric intestinal metaplasia (IM) is generally considered as a precancerous condition, a related risk factor for intestinal-type gastric cancer. However, an accurate endoscopic diagnosis of IM is a clinical challenge. Confocal Laser Endomicroscopy (CLE) is a newly technique that can provide real-time magnified images and visualize tissues at cellular or subcellular levels. The aim of this study is to clarify the diagnostic value of CLE in detection of IM in patients at high risk of gastric cancer. METHODS Systematic literature searches up to April 2015 in PubMed, Embase, Web of Science, Cochrane Library databases were conducted by two reviewers independently. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was applied to assess study quality and to reduce potential bias. A meta-analysis using Meta-Disc (version 1.4) and STATA software (version 13) was performed. RESULTS A total of four studies enrolled 218 patients and 579 lesions were included in this meta-analysis. On per-lesion basis, the pooled sensitivity and specificity of CLE were 0.97(95 % confidence interval (CI) = 0.94-0.98) and 0.94 (95 % CI = 0.91-0.97) respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 15.20 (95 % CI = 9.46-24.41) and 0.04 (95 % CI = 0.02-0.07) respectively. The pooled diagnostic odds ratio (DOR) was 479.59 (95 % CI = 205.64-1118.51) and summary receiver operating curve (SROC) area under the curve was 0.9884. There was no statistical significance of publication bias. CONCLUSION CLE is a promising endoscopic tool in the detection of IM with the relatively high diagnostic value in patients at high risk of gastric cancer.
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Affiliation(s)
- Xing-Kang He
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, 310016, China.,Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, 310016, China
| | - Dan Liu
- Department of Statistics, Texas A & M University, College Station, TX, 77843, USA
| | - Lei-Min Sun
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, 310016, China. .,Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, 310016, China.
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Qian W, Bai T, Wang H, Zhang L, Song J, Hou XH. Meta-analysis of confocal laser endomicroscopy for the diagnosis of gastric neoplasia and adenocarcinoma. J Dig Dis 2016; 17:366-76. [PMID: 27129127 DOI: 10.1111/1751-2980.12357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 03/10/2016] [Accepted: 04/25/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Confocal laser endomicroscopy (CLE) is a recently developed technique used to diagnose gastrointestinal diseases. The current meta-analysis aimed to systematically assess the ability of CLE to diagnose neoplasia and gastric adenocarcinoma. METHODS A comprehensive literature search was performed using PubMed, Embase and the Cochrane Library for endomicroscopy, gastric neoplasia and gastric adenocarcinoma. Sensitivity and specificity data on the diagnosis of neoplasia and gastric adenocarcinoma were pooled. A summary receiver operating characteristic (sROC) curve was performed and the area under the curve was calculated. RESULTS In all, 13 studies were included in the current study. The pooled sensitivity and specificity assessing CLE as a method to diagnose gastric neoplasia were 0.81 and 0.98, respectively. For the diagnosis of gastric adenocarcinoma, the pooled sensitivity and specificity were 0.89 and 0.99, respectively. The pooled sensitivity and specificity were 0.82 and 0.95 when differentiating high-grade intraepithelial neoplasia from low-grade intraepithelial neoplasia. Additionally, the pooled sensitivity and specificity were 0.87 and 0.96, respectively, when distinguishing undifferentiated gastric adenocarcinoma from differentiated gastric adenocarcinoma. CONCLUSION CLE has a high sensitivity and specificity for diagnosing gastric intraepithelial neoplasia and gastric adenocarcinoma; therefore, it could be considered an alternative to the endoscopic method used to diagnose gastric intraepithelial neoplasia and gastric adenocarcinoma.
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Affiliation(s)
- Wei Qian
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Tao Bai
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Huan Wang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Lei Zhang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jun Song
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiao Hua Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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