BACKGROUND & AIMS: The preoperative diagnosis of cholangiocarcinoma is associated with a low sensitivity. To overcome this limitation, a new imaging modality was evaluated to detect neoplasia in vivo in the biliary tract. METHODS: Fourteen patients with biliary strictures were examined. Mucosal imaging was performed with a miniaturized confocal laser scanning miniprobe introduced via the accessory channel of a cholangioscope. Thereafter, targeted biopsy specimens were taken from the same regions. RESULTS: All strictures could be reached. Presence of irregular vessels use confocal laser microscopy enabled prediction of neoplasia with an accuracy rate of 86%, sensitivity of 83%, and specificity of 88%. The respective numbers for standard histopathology were 79%, 50%, and 100%. The mean signal-to-noise-ratio of laser microscopic images acquired from malignant strictures differed significantly from those of benign origin (1.8 +/- 0.8 vs 2.6 +/- 1.0; P = .005). CONCLUSIONS: Miniprobe-based confocal laser scanning microscopy considerably increases sensitivity for the detection of biliary neoplasia and therefore represents a promising diagnostic approach.
BACKGROUND & AIMS: The preoperative diagnosis of cholangiocarcinoma is associated with a low sensitivity. To overcome this limitation, a new imaging modality was evaluated to detect neoplasia in vivo in the biliary tract. METHODS: Fourteen patients with biliary strictures were examined. Mucosal imaging was performed with a miniaturized confocal laser scanning miniprobe introduced via the accessory channel of a cholangioscope. Thereafter, targeted biopsy specimens were taken from the same regions. RESULTS: All strictures could be reached. Presence of irregular vessels use confocal laser microscopy enabled prediction of neoplasia with an accuracy rate of 86%, sensitivity of 83%, and specificity of 88%. The respective numbers for standard histopathology were 79%, 50%, and 100%. The mean signal-to-noise-ratio of laser microscopic images acquired from malignant strictures differed significantly from those of benign origin (1.8 +/- 0.8 vs 2.6 +/- 1.0; P = .005). CONCLUSIONS: Miniprobe-based confocal laser scanning microscopy considerably increases sensitivity for the detection of biliary neoplasia and therefore represents a promising diagnostic approach.
Authors: Kenneth K Wang; David L Carr-Locke; Satish K Singh; Helmut Neumann; Helga Bertani; Jean-Paul Galmiche; Razvan I Arsenescu; Fabrice Caillol; Kenneth J Chang; Stanislas Chaussade; Emmanuel Coron; Guido Costamagna; Aldona Dlugosz; S Ian Gan; Marc Giovannini; Frank G Gress; Oleh Haluszka; Khek Y Ho; Michel Kahaleh; Vani J Konda; Frederic Prat; Raj J Shah; Prateek Sharma; Adam Slivka; Herbert C Wolfsen; Alvin Zfass Journal: United European Gastroenterol J Date: 2015-06 Impact factor: 4.623