Miniprobe confocal laser microscopy for the detection of invisible neoplasia in patients with Barrett's oesophagus

PohI, H; Rösch, T; Vieth, M; Koch, M; Becker, V; Anders, M; Khalifa, A C; Meining, A
December 2008
Gut;Dec2008, Vol. 57 Issue 12, p1648
Academic Journal
Objective: The biggest challenge in endoscopic surveil lance of Barrett's oesophagus is better detection of neoplasia in mucosa of normal macroscopic appearanc~ We evaluated in vivo miniprobe confocal laser microsco~ (CLM) for the detection of invisible Barrett's neoplasia. Design: Prospective two-centre trial in two phases: phase I to establish criteria of Barrett's neoplasia and phase II to test these criteria. Patients and intervention: 296 biopsy sites in 38 consecutive patients with Barrett's oesophagus (mean age 62.1 years, 89.5% men, median length of the Barrett's oesophagus, 3 cm) were examined with standard high-resolution endoscopy and by miniprobe CLM, with precise matching of CLM recordings to biop~ sites. CLM image criteria for normal versus neoplastic Barrett's oesophagus were established from 95 biopsie of 15 patients (phase I); these criteria were then prospectively tested on 201 biopsies from the remainin patients without visible focal changes (phase II). All 20 CLM video recordings from phase II cases were randomised and blindly evaluated by two gastroenterol- ogists. Main outcome measure: The primary endpoints wer~ accuracy values in diagnosing HGIN or early carcinoma (EC) on a per-biopsy basis. Secondary endpoints include inter-observer agreement. Results: All initially defined miniprobe CLM criteria (phase I) were significantly more frequently detected ir HGIN/EC sites compared with sites with no or low grad neoplasia (phase II). In a per-biopsy analysis, sensitivit~ and specificity for two independent investigators were 75.0% and 88.8%, and 75.0% and 91.0%, respectively, translating at best into a positive predictive value of 44.4% and a negative predictive value of 98.8%. Inter- observer agreement was good (kappa 0.6). Conclusion: Miniprobe CLM showed a high negative predictive value for the diagnosis of endoscopically invisible neoplasia in Barrett's oesophagus; sensitivity, however, has still to be improved.


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