Value of endoscopy with narrow-band imaging and probe-based confocal laser endomicroscopy in the diagnosis of preneoplastic lesions of gastrointestinal tract

Abstract

Introduction: Amongst all malignant tumors, cancers of the digestive tract rank first in terms of yearly deaths. Patients above 60 years of age are the most affected, as the diagnosis is frequently made in advanced stages of the disease when therapy is less effective. Our study aimed to evaluate the efficiency of narrow-band imaging (NBI) endoscopy and probe-based confocal laser endomicroscopy (pCLE) in the correct diagnosis of preneoplastic lesions in the upper and lower digestive tract. Patients, Materials and Methods: We included 46 patients with digestive preneoplastic lesions, who underwent either upper or lower digestive endoscopy, followed by NBI and pCLE. We recorded 5-10 frames per each lesion, from different angles and distances during white-light endoscopy and selected frames from full recordings of NBI and pCLE. Usual preparation was used for the endoscopic procedures; pCLE required in vivo administration of 10% Sodium Fluorescein as a contrast agent. Pathology was performed in case of solid tumors. Three medical professionals with different levels of training, blinded to the results, interpreted the data. Results: The experienced physician correlated very well the NBI findings with pathology (0.93, p=0.05), while the resident physician and the experienced nurse obtain lower, albeit still statistically significant, values (0.73 and 0.62, respectively). For pCLE, the experienced physician obtained near-perfect correlation with pathology (0.96), followed closely by the resident physician (0.93). The nurse obtained a modest correlation (0.42). All examiners obtained approximately equal performances in discerning between malignant and benign lesions. Conclusions: Digestive endoscopy in NBI mode proved its effectiveness. Even less experienced endoscopists can achieve good results, while an experienced nurse can positively influence the diagnosis. In the case of pCLE, when available, it can greatly reduce diagnostic times, while requiring higher expertise and specialty training.

Role of Contrast-Enhanced Ultrasonography in Hepatocellular Carcinoma by Using LI-RADS and Ancillary Features: A Single Tertiary Centre Experience

“…To date, CEUS is considered to be a second-line imaging technique in the characterization of FLL, having the advantage of a low cost. Beyond contrast-enhanced MRI as the method of choice for characterizing FLL, there are studies concluding that there are no statistically significant differences between CEUS and MRI or CT [ 9 , 13 , 14 ]. However, the differential diagnosis between HCC, cholangiocarcinoma and liver metastases may be limited by similarities in the appearance of CEUS.…”

The differential diagnosis of ulcerative colitis versus angiodysplasia of the colon with ischemic colitis

“…Patients with angiodysplasia usually present with maroon-colored stool, melena, hematochezia or hemoccult positive stool. Bleeding is usually low grade, but it can be massive in approximately 15% of patients and although stops spontaneously in greater than 90% of cases, is often recurrent [ 10 , 11 ].…”

Classification of the Confocal Microscopy Images of Colorectal Tumor and Inflammatory Colitis Mucosa Tissue Using Deep Learning

“…In recent years, there has been increased interest worldwide in exploring methods for the prevention, diagnosis, and improved visualization of CRC [ 2 , 3 , 4 , 5 ]. Most techniques [ 9 , 10 , 11 , 12 ] integrate confocal laser endomicroscopy (CLE) and narrow banding imaging into the tip of a flexible endoscope to provide high-resolution endomicroscopy for real-time virtual biopsies. For example, the Cellvizio probe-based CLE has been commercialized.…”