Diagnostic accuracy of confocal laser endomicroscopy in diagnosing dysplasia in patients affected by long-standing ulcerative colitis  

作　　者：Antonio Rispo Fabiana Castiglione Stefania Staibano Dario Esposito Maria Siano Francesco Maione Francesca Salvatori Stefania Masone Marcello Persico Giovanni Domenico De Palma 

机构地区：Gastroenterology,University 'Federico Ⅱ'of Naples,80131 Naples,Italy Gastroenterology,University 'Federico Ⅱ' of Naples,80131 Naples,Italy Department of Biomorphological and Functional Sciences,Section of Pathology,University 'Federico Ⅱ' of Naples,80131 Naples,Italy Surgery and Advanced Technologies-University 'Federico Ⅱ' of Naples,80131 Naples,Italy Department of Biomorphological and Functional Sciences,Section of Pathology,University'Federico Ⅱ'of Naples,80131 Naples,Italy Surgery and Advanced Technologies-University 'Federico Ⅱ'of Naples,80131 Naples,Italy

出　　处：《World Journal of Gastrointestinal Endoscopy》2012年第9期414-420,共7页世界胃肠内镜杂志（英文版）（电子版）

摘　　要： AIM:To evaluate the diagnostic accuracy of confocal laser endomicroscopy(CLE) for the detection of dysplasia in long-standing ulcerative colitis(UC).METHODS:We prospectively performed a surveillance colonoscopy in 51 patients affected by long-standing UC.Also,in the presence of macroscopic areas with suspected dysplasia,both targeted contrasted indigo carmine endoscopic assessment and probe-based CLE were performed.Colic mucosal biopsies and histology,utilised as the gold standard,were assessed randomly and on visible lesions,in accordance with current guidelines.RESULTS:Fourteen of the 51 patients(27%) showed macroscopic mucosal alterations with the suspected presence of dysplasia,needing chromoendoscopic and CLE evaluation.In 5 macroscopically suspected cases,the presence of dysplasia was confirmed by histology(3 flat dysplasia;2 DALMs).No dysplasia/cancer was found on any of the outstanding random biopsies.The diagnostic accuracy of CLE for the detection of dysplasia compared to standard histology was sensitivity 100%,specificity 90%,positive predictive value 83% and negative predictive value 100%.CONCLUSION:CLE is an accurate tool for the detection of dysplasia in long-standing UC and shows optimal values of sensitivity and negative predictivity.The scheduled combined application of chromoendoscopy and CLE could maximize the endoscopic diagnostic accuracy for diagnosis of dysplasia in UC patients,thus limiting the need for biopsies.AIM: To evaluate the diagnostic accuracy of confocal laser endomicroscopy (CLE) for the detection of dysplasia in long-standing ulcerative colitis (UC). METHODS: We prospectively performed a surveillance colonoscopy in 51 patients affected by long-standing UC. Also, in the presence of macroscopic areas with suspected dysplasia, both targeted contrasted indigo carmine endoscopic assessment and probe-based CLE were performed. Colic mucosal biopsies and histology, utilised as the gold standard, were assessed randomly and on visible lesions, in accordance with current guidelines. RESULTS: Fourteen of the 51 patients (27%) showed macroscopic mucosal alterations with the suspected presence of dysplasia, needing chromoendoscopic and CLE evaluation. In 5 macroscopically suspected cases, the presence of dysplasia was confirmed by histology (3 flat dysplasia; 2 DALMs). No dysplasia/cancer was found on any of the outstanding random biopsies. The diagnostic accuracy of CLE for the detection of dysplasia compared to standard histology was sensitivity 100%, specificity 90%, positive predictive value 83% and negative predictive value 100%. CONCLUSION: CLE is an accurate tool for the detection of dysplasia in long-standing UC and shows optimal values of sensitivity and negative predictivity. The scheduled combined application of chromoendoscopy and CLE could maximize the endoscopic diagnostic accuracy for diagnosis of dysplasia in UC patients, thus limiting the need for biopsies.

关 键 词：ULCERATIVE COLITIS Cancer CONFOCAL Surveillance 

分 类 号：R574.62[医药卫生—消化系统]