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Surgical Endoscopy

Published in:

01-02-2017

Probe-based confocal laser endomicroscopy for evaluating the submucosal invasion of colorectal neoplasms

Authors: Bun Kim, Yon Hee Kim, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Won Ho Kim, Hoguen Kim, Sung Pil Hong

Published in: Surgical Endoscopy | Issue 2/2017

Abstract

Background

Probe-based confocal laser endomicroscopy (pCLE) is a novel method for in vivo histological analysis of colorectal neoplasm mucosa, which provides meaningful information for the development of adequate therapeutic strategies. However, the in vivo histology of colorectal neoplasm submucosa has not been studied. We assessed the feasibility and safety of pCLE for evaluating colorectal submucosa, and identified and validated diagnostic criteria for submucosal carcinoma infiltration.

Methods

From March to July 2014, 83 pCLE videos of 51 lesions in 31 patients who underwent scheduled colonoscopic procedures for the removal of colorectal neoplasms were acquired consecutively. During the procedures, pCLE videos of the lesions and biopsy samples for histopathological analysis were acquired. Final histopathological results were used as the gold standard.

Results

Based on the confocal pattern, we classified colorectal submucosa findings as negative (superficial submucosa, deep submucosa, and submucosa with fibrosis) or indicative of carcinoma infiltration. Dark and irregular cell nests with irregular cell architecture and little or no mucin were seen in submucosal carcinoma infiltration. Based on rates of correlation with pathological findings, the sensitivity, specificity, and accuracy of the classification of submucosal carcinoma infiltration by two observers were 91.7, 86.8, and 88.0 %, respectively. In addition, the results showed good interobserver agreement for the detection of submucosal carcinoma infiltration (κ = 0.757, standard error = 0.102). No adverse events occurred during the procedures.

Conclusions

Submucosa assessment by pCLE is feasible and safe. pCLE is useful for the differentiation of normal submucosa from carcinoma infiltration, particularly when infiltration is accompanied by severe fibrosis. Large-scale prospective studies are needed to further evaluate the clinical impact of the use of pCLE during endoscopy.

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Title: Probe-based confocal laser endomicroscopy for evaluating the submucosal invasion of colorectal neoplasms
Authors: Bun Kim
Yon Hee Kim
Soo Jung Park
Jae Hee Cheon
Tae Il Kim
Won Ho Kim
Hoguen Kim
Sung Pil Hong
Publication date: 01-02-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5003-x

At a glance: The STEP trials

Springer Medicine

Probe-based confocal laser endomicroscopy for evaluating the submucosal invasion of colorectal neoplasms

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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