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Villeneuve T, Hermant C, Le Borgne A, Murris M, Plat G, Héluain V, Colombat M, Courtade-Saïdi M, Evrard S, Collot S, Salaün M, Guibert N. Real-time and non-invasive acute lung rejection diagnosis using confocal LASER Endomicroscopy in lung transplant recipients: Results from the CELTICS study. Pulmonology 2024:S2531-0437(24)00014-X. [PMID: 38402125 DOI: 10.1016/j.pulmoe.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Traditionally, the diagnosis of acute rejection (AR) relies on invasive transbronchial biopsies (TBBs) to obtain histopathological samples. We aimed to evaluate the diagnostic yield of probe-based confocal laser endomicroscopy (pCLE) as a complementary and non-invasive tool for ACR screening, comparing its results with those obtained from TBBs. METHODS Between January 2015 and April 2022, we conducted a retrospective study of all lung transplant recipients aged over 18 years at Toulouse University Hospital (France). All patients who underwent bronchoscopies with both TBBs and pCLE imaging were included. Two experienced interpreters (TV and MS) reviewed the pCLE images independently, blinded to all clinical information and pathology results. RESULTS From 120 procedures in 85 patients, 34 abnormal histological samples were identified. Probe-based confocal laser endomicroscopy revealed significant associations between both alveolar (ALC) and perivascular (PVC) cellularities and abnormal histological samples (p<0.0001 and 0.003 respectively). Alveolar cellularity demonstrated a sensitivity (Se) of 85.3 %, specificity (Spe) of 43 %, positive predictive value (PPV) of 37.2 % and negative predictive value (NPV) of 88.1 %. For PVC, Se was 70.6 %, Spe 80.2 %, PPV 58.5 % and NPV 87.3 %. Intra-interpreter correlation (TV) was 88.3 % for the number of vessels (+/-1), 98.3 % for ALC and 90 % for PVC. Inter-interpreter correlation (TV and MS) was 80 % for vessels (+/-1), 97.5 % for ALC and 83.3 % for PVC. CONCLUSION Our study demonstrates the feasibility of incorporating pCLE into clinical practice, demonstrating good diagnostic yield and reproducible outcomes in the screening of AR in lung transplant recipients.
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Affiliation(s)
- T Villeneuve
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France.
| | - C Hermant
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France
| | - A Le Borgne
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France
| | - M Murris
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France
| | - G Plat
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France
| | - V Héluain
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France
| | - M Colombat
- Cytology and Pathology Department, University Cancer Institute, Toulouse, France
| | - M Courtade-Saïdi
- Cytology and Pathology Department, University Cancer Institute, Toulouse, France
| | - S Evrard
- Cytology and Pathology Department, University Cancer Institute, Toulouse, France
| | - S Collot
- Radiology Department, Toulouse University Hospital, Toulouse, France
| | - M Salaün
- Respiratory Medicine Department, Department, Rouen University Hospital, Toulouse, France
| | - N Guibert
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France
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Danilevskaya O, Sazonov D, Klypa T, Zabozlaev F, Popova E. Confocal laser endomicroscopy in a critically ill COVID-19 patient. Tuberc Respir Dis (Seoul) 2022; 85:273-275. [PMID: 35320666 PMCID: PMC9263342 DOI: 10.4046/trd.2022.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Olesya Danilevskaya
- Department of Endoscopy, FSBI Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the Federal Medical Biological Agency of Russia, Moscow, Russia.,Laboratory of clinical pulmonology, FSBI Pulmonology Scientific Research Institute under Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Dmitry Sazonov
- Department of Endoscopy, FSBI Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Tatyana Klypa
- Intensive Care Unit, FSBI Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Fedor Zabozlaev
- Department Of Pathology, FSBI Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Elena Popova
- Laboratory of clinical pulmonology, FSBI Pulmonology Scientific Research Institute under Federal Medical Biological Agency of Russia, Moscow, Russia
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Al-Mansour MR, Caycedo-Marulanda A, Davis BR, Alawashez A, Docimo S, Qureshi A, Tsuda S. SAGES TAVAC safety and efficacy analysis confocal laser endomicroscopy. Surg Endosc 2021; 35:2091-103. [PMID: 32405892 DOI: 10.1007/s00464-020-07607-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Capuano A, Andreuzzi E, Pivetta E, Doliana R, Favero A, Canzonieri V, Maiero S, Fornasarig M, Magris R, Cannizzaro R, Mongiat M, Spessotto P. The Probe Based Confocal Laser Endomicroscopy ( pCLE) in Locally Advanced Gastric Cancer: A Powerful Technique for Real-Time Analysis of Vasculature. Front Oncol 2019; 9:513. [PMID: 31263680 PMCID: PMC6584847 DOI: 10.3389/fonc.2019.00513] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/29/2019] [Indexed: 12/24/2022] Open
Abstract
Probe based confocal laser endomicroscopy (pCLE) is an advanced technique which provides imaging of gastrointestinal mucosa at subcellular resolution and, importantly, a valid tool for the evaluation of microvasculature during endoscopic examination. In order to assess intratumoral vascularization and the efficiency of blood flow in locally advanced gastric cancer, we examined 57 patients through pCLE imaging. The vascular alterations in gastric cancer were mainly characterized by leakage and by the presence of tortuous and large size vessels. Defects in blood flow were detected very rarely. No association between the angiogenic score and the gastric tumor site or histological type was observed. Interestingly, no correlation was also found with the tumor grading indicating that the vascular angiogenic anomalies in gastric cancer represent an early pathological event to be observed and detected. The majority of patients displayed unchanged vascular alterations following neoadjuvant chemotherapy and this positively correlated with stable or progressive disease, suggesting that an unaltered angiogenic score could per se be indicative of poor therapeutic efficacy. Different vascular parameters were evaluated by immunofluorescence using bioptic samples and the vessel density did not correlate with clinical staging, site or histologic type. Interestingly, only CD105, Multimerin-2 and GLUT1 were able to discriminate normal from tumoral gastric mucosa. Taken together, these findings indicate that functional and structural angiogenic parameters characteristic of tumor blood network were fully detectable by pCLE. Moreover, the evaluation of tumor vasculature by real-time assessment may provide useful information to achieve tailored therapeutic interventions for gastric cancer patients.
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Affiliation(s)
- Alessandra Capuano
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Eva Andreuzzi
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Eliana Pivetta
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Roberto Doliana
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Andrea Favero
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | | | - Stefania Maiero
- Oncological Gastroenterology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Mara Fornasarig
- Oncological Gastroenterology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Raffaella Magris
- Oncological Gastroenterology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Renato Cannizzaro
- Oncological Gastroenterology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Maurizio Mongiat
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Paola Spessotto
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
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Ignat M, Lindner V, Vix M, Marescaux J, Mutter D. Intraoperative Probe-Based Confocal Endomicroscopy to Histologically Differentiate Thyroid From Parathyroid Tissue Before Resection. Surg Innov 2018; 26:141-148. [PMID: 30466375 DOI: 10.1177/1553350618814078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Frozen section is the standard method to histologically distinguish parathyroid tissue from thyroid tissue during endocrine neck surgery. Frozen section can be time-consuming and costly. Its drawback is that it is to be performed only after the removal of a suspected pathological tissue. This study demonstrates the use of probe-based confocal laser endomicroscopy (pCLE) to confirm histology prior to tissue resection. DESIGN A prospective, single-institution, nonrandomized study was conducted. No sample size calculation was performed for this observational trial. The primary objective was the description of histological rendering of normal and pathological tissues through pCLE. Real-time in vivo fluorescence microscopy imaging was performed with the CystoFlex UHD probe after intravenous injection of 2.5 mL of 10% fluorescein sodium. RESULTS Eleven patients with hyperparathyroidism and thyroid conditions were included. A total of 104 videos showing thyroid, parathyroid, adipose tissue, muscle, laryngeal nerve, and lymph nodes were recorded. Videos were compared with visual information and pathological samples (when sampling was indicated). Thyroid tissue could be identified based on the presence of colloid follicles (intensely fluorescent area surrounded by a small ridge of low-fluorescence epithelial cells) including the pathognomonic aspect of resorption vacuole. Parathyroid tissue could be identified based on a regular, "diamond-shaped" capillary network encompassing parathyroid chief cells. Blinded reinterpretation of pCLE videos demonstrated an 89.3% sensitivity and a 90% specificity as compared with histology in tissue recognition. CONCLUSION This pilot study describes representative renderings of intraoperative pCLE to nontraumatically differentiate thyroid, parathyroid, and lymph nodes before surgical removal.
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Affiliation(s)
- Mihaela Ignat
- 1 University Hospital of Strasbourg, Strasbourg, France.,2 IRCAD/IHU: Institute of Image-Guided Surgery, Strasbourg, France
| | | | - Michel Vix
- 1 University Hospital of Strasbourg, Strasbourg, France.,2 IRCAD/IHU: Institute of Image-Guided Surgery, Strasbourg, France
| | | | - Didier Mutter
- 1 University Hospital of Strasbourg, Strasbourg, France.,2 IRCAD/IHU: Institute of Image-Guided Surgery, Strasbourg, France
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Kahaleh M, Turner BG, Bezak K, Sharaiha RZ, Sarkaria S, Lieberman M, Jamal-Kabani A, Millman JE, Sundararajan SV, Chan C, Mehta S, Widmer JL, Gaidhane M, Giovannini M. Probe-based confocal laser endomicroscopy in the pancreatic duct provides direct visualization of ductal structures and aids in clinical management. Dig Liver Dis 2015; 47:202-4. [PMID: 25499063 DOI: 10.1016/j.dld.2014.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/18/2014] [Accepted: 11/04/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Confocal endomicroscopy provides real-time evaluation of various sites and has been used to provide detailed endomicroscopic imaging of the biliary tree. We aimed to evaluate the feasibility and utility of probe-based confocal laser endomicroscopy of the pancreatic duct as compared to cytologic and histologic results in patients with indeterminate pancreatic duct strictures. METHODS Retrospective data on patients with indeterminate pancreatic strictures undergoing endoscopic retrograde cholangiopancreatography (ERCP) and confocal endomicroscopy were collected from two tertiary care centres. Real-time confocal endomicroscopy images were obtained during ERCP and immediate interpretation according to the Miami Classification was performed. RESULTS 18 patients underwent confocal endomicroscopy for evaluation of pancreatic strictures from July 2011 to December 2012. Mean pancreatic duct size was 4.2mm (range 2.2-8mm). Eight cases were interpreted as benign, 4 as malignant, 4 suggestive of intraductal papillary mucinous neoplasms, and 2 appeared normal. Cytology/histopathology for 15/16 cases showed similar results to confocal endomicroscopy interpretation. Kappa coefficient of agreement between cyto/histopathology and confocal endomicroscopy was 0.8 (p=0.0001). Pancreatic confocal endomicroscopy changed management in four patients, changing the type of surgery from total pancreatectomy to whipple. CONCLUSIONS Confocal endomicroscopy is effective in assisting with diagnosis of indeterminate pancreatic duct strictures as well as mapping of abnormal pancreatic ducts prior to surgery.
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Affiliation(s)
- Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
| | - Brian G Turner
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Karl Bezak
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Savreet Sarkaria
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Michael Lieberman
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Armeen Jamal-Kabani
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Jennifer E Millman
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Subha V Sundararajan
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Ching Chan
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Shivani Mehta
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Jessica L Widmer
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Monica Gaidhane
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Marc Giovannini
- Department of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
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Nathan CAO, Kaskas NM, Ma X, Chaudhery S, Lian T, Moore-Medlin T, Shi R, Mehta V. Confocal Laser Endomicroscopy in the Detection of Head and Neck Precancerous Lesions. Otolaryngol Head Neck Surg 2014. [PMID: 24699456 DOI: 10.1177/019459981452866010.1177/0194599814528660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE This study aimed to determine the feasibility of using probe-based confocal laser endomicroscopy (pCLE) in the diagnostic differentiation of non-neoplastic lesions from precancerous and cancerous lesions of head and neck patients. STUDY DESIGN Diagnostic test evaluation. SETTING Louisiana State University Health Shreveport. SUBJECTS AND METHODS Intravenous injection of fluorescein was given to patients with precancerous and cancerous head and neck lesions (n = 21) followed by the use of a 1.8-mm GastroFlex probe in the oral cavity with subsequent biopsies of selected areas. Probe-based confocal laser endomicroscopy images were compared to histologic evaluation of visualized sites using sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). RESULTS The dorsal surface of the tongue was not well visualized. The remaining nonkeratinized subsites, including the buccal mucosa, floor of mouth, and ventral tongue, were well visualized. Diagnoses based on pCLE images correlated well with the gold standard diagnoses based on tissue histology. The overall sensitivity for diagnosis of dysplasia versus nondysplasia was 80.0% (95% confidence interval [CI], 62.0-98.0), specificity and PPV were 100%, and the NPV was 80.0% (95% CI, 60.0-100.0). The overall specificity, sensitivity, PPV, and NPV for pCLE diagnosis of carcinoma versus nondysplasia were 100%. The overall sensitivity for diagnosis of carcinoma versus dysplasia was 85.7% (95% CI, 73.0-99.0), specificity and PPV were 100%, and the NPV was 80.0% (95% CI, 60.0-100.0). CONCLUSION The pCLE is a promising method for differentiating between nondysplastic, precancerous, and cancerous lesions of the head and neck.
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Affiliation(s)
- Cherie-Ann O Nathan
- Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Nadine M Kaskas
- Louisiana State University Health Shreveport School of Medicine, Shreveport, Louisiana, USA
| | - Xiaohui Ma
- Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Shubnum Chaudhery
- Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA Department of Pathology, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Timothy Lian
- Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Tara Moore-Medlin
- Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Runhua Shi
- Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Vikas Mehta
- Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
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Canto MI, Anandasabapathy S, Brugge W, Falk GW, Dunbar KB, Zhang Z, Woods K, Almario JA, Schell U, Goldblum J, Maitra A, Montgomery E, Kiesslich R. In vivo endomicroscopy improves detection of Barrett's esophagus-related neoplasia: a multicenter international randomized controlled trial (with video). Gastrointest Endosc 2014; 79:211-21. [PMID: 24219822 PMCID: PMC4668117 DOI: 10.1016/j.gie.2013.09.020] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/18/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Confocal laser endomicroscopy (CLE) enables in vivo microscopic imaging of the GI tract mucosa. However, there are limited data on endoscope-based CLE (eCLE) for imaging Barrett's esophagus (BE). OBJECTIVE To compare high-definition white-light endoscopy (HDWLE) alone with random biopsy (RB) and HDWLE + eCLE and targeted biopsy (TB) for diagnosis of BE neoplasia. DESIGN Multicenter, randomized, controlled trial. SETTING Academic medical centers. PATIENTS Adult patients with BE undergoing routine surveillance or referred for early neoplasia. INTERVENTION Patients were randomized to HDWLE + RB (group 1) or HDWLE + eCLE + TB (group 2). Real-time diagnoses and management plans were recorded after HDWLE in both groups and after eCLE in group 2. Blinded expert pathology diagnosis was the reference standard. MAIN OUTCOME MEASUREMENTS Diagnostic yield, performance characteristics, clinical impact. RESULTS A total of 192 patients with BE were studied. HDWLE + eCLE + TB led to a lower number of mucosal biopsies and higher diagnostic yield for neoplasia (34% vs 7%; P < .0001), compared with HDWLE + RB but with comparable accuracy. HDWLE + eCLE + TB tripled the diagnostic yield for neoplasia (22% vs 6%; P = .002) and would have obviated the need for any biopsy in 65% of patients. The addition of eCLE to HDWLE increased the sensitivity for neoplasia detection to 96% from 40% (P < .0001) without significant reduction in specificity. In vivo CLE changed the treatment plan in 36% of patients. LIMITATIONS Tertiary-care referral centers and expert endoscopists limit generalizability. CONCLUSION Real-time eCLE and TB after HDWLE can improve the diagnostic yield and accuracy for neoplasia and significantly impact in vivo decision making by altering the diagnosis and guiding therapy. ( CLINICAL TRIAL REGISTRATION NUMBER NCT01124214.).
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Affiliation(s)
- Marcia Irene Canto
- Johns Hopkins University, Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
| | | | - William Brugge
- Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gary W. Falk
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kerry B. Dunbar
- Dallas Veterans Affairs Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zhe Zhang
- Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Kevin Woods
- Emory University School of Medicine/Emory University Hospital, Atlanta, Georgia, USA
| | - Jose Antonio Almario
- Johns Hopkins University, Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
| | | | - John Goldblum
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Anirban Maitra
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Elizabeth Montgomery
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Latt WT, Chang TP, Di Marco A, Pratt P, Kwok KW, Clark J, Yang GZ. A Hand-held Instrument for in vivo Probe-based Confocal Laser Endomicroscopy during Minimally Invasive Surgery. Rep U S 2012; 2012:1982-1987. [PMID: 24748997 DOI: 10.1109/iros.2012.6385535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Probe-based confocal laser endomicroscopy (pCLE) provides high resolution imaging of tissue in vivo. Maintaining a steady contact between target tissue and pCLE probe tip is important for image consistency. In this paper, a new prototype hand-held instrument for in vivo pCLE during Minimally Invasive Surgery (MIS) is presented. The proposed instrument incorporates adaptive force sensing and actuation, allowing improved image consistency and force control, thus minimizing tissue deformation and induced micro-structural variations. The performance and accuracy of the contact force control are evaluated in detailed laboratory settings and in vivo validation of the device during transanal microsurgery in a live porcine model further demonstrates the potential clinical value of the device.
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Affiliation(s)
| | - Tou Pin Chang
- Department of Surgery & Cancer, Imperial College London, UK.
| | - Aimee Di Marco
- Department of Surgery & Cancer, Imperial College London, UK
| | - Philip Pratt
- Hamlyn Centre for Robotic Surgery, Imperial College London, UK
| | - Ka-Wai Kwok
- Hamlyn Centre for Robotic Surgery, Imperial College London, UK
| | - James Clark
- Department of Surgery & Cancer, Imperial College London, UK
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