Jose Andres Guerrero1, Javiera Pérez-Anker2, Gloria Fernández-Esparrach3,4,5,6, Ivan Archilla1,5, Alba Diaz1,4,5, Sandra Lopez-Prades1,5, Maite Rodrigo-Calvo1,5, Sara Lahoz4,6,7, Jordi Camps4,6,7,8, Susana Puig2,4,5, Josep Malvehy2,4,5, Miriam Cuatrecasas1,4,5,6,9. 1. Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain. 2. Dermatology Department, Hospital Clinic, Barcelona, Spain. 3. Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic, Barcelona, Spain. 4. University of Barcelona, Barcelona, Spain. 5. Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 6. Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain. 7. Gastrointestinal and Pancreatic Oncology Team, Hospital Clínic, Barcelona, Spain. 8. Department of Cell Biology, Physiology and Immunology, Faculty of Medicine, University Autonomous of Barcelona, Bellaterra, Spain. 9. Banc de Teixits-Biobanc Clinic-IDIBAPS, Barcelona, Spain.
Abstract
BACKGROUND: Colorectal cancer screening programs have accomplished a mortality reduction from the disease but have created bottlenecks in endoscopy units and pathology departments. We aimed to explore the feasibility of ex vivo fusion confocal microscopy (FuCM) to improve the histopathology diagnostic efficiency and reduce laboratory workload. METHODS: Consecutive fresh polyps removed at colonoscopy were scanned using ex vivo FuCM, then went through histopathologic workout and hematoxylin and eosin (H&E) diagnosis. Two pathologists blinded to H&E diagnosis made a diagnosis based on FuCM scanned images. RESULTS: Thirty-six fresh polyps from 22 patients were diagnosed with FuCM and H&E. Diagnostic agreement between H&E and FuCM was 97.2% (kappa = 0.96) for pathologist #1 and 91.7% (kappa = 0.87) for pathologist #2. Diagnostic performance concordance between FuCM and H&E to discern adenomatous from nonadenomatous polyps was 100% (kappa = 1) for pathologist #1 and 97.2% (kappa = 0.94) for pathologist #2. Global interobserver agreement was 94.44% (kappa = 0.91) and kappa = 0.94 to distinguish adenomatous from nonadenomatous polyps. CONCLUSIONS: Ex vivo FuCM shows an excellent correlation with standard H&E for the diagnosis of colorectal polyps. The clinical direct benefit for patients, pathologists, and endoscopists allows adapting personalized surveillance protocols after colonoscopy and a workload decrease in pathology departments.
BACKGROUND: Colorectal cancer screening programs have accomplished a mortality reduction from the disease but have created bottlenecks in endoscopy units and pathology departments. We aimed to explore the feasibility of ex vivo fusion confocal microscopy (FuCM) to improve the histopathology diagnostic efficiency and reduce laboratory workload. METHODS: Consecutive fresh polyps removed at colonoscopy were scanned using ex vivo FuCM, then went through histopathologic workout and hematoxylin and eosin (H&E) diagnosis. Two pathologists blinded to H&E diagnosis made a diagnosis based on FuCM scanned images. RESULTS: Thirty-six fresh polyps from 22 patients were diagnosed with FuCM and H&E. Diagnostic agreement between H&E and FuCM was 97.2% (kappa = 0.96) for pathologist #1 and 91.7% (kappa = 0.87) for pathologist #2. Diagnostic performance concordance between FuCM and H&E to discern adenomatous from nonadenomatous polyps was 100% (kappa = 1) for pathologist #1 and 97.2% (kappa = 0.94) for pathologist #2. Global interobserver agreement was 94.44% (kappa = 0.91) and kappa = 0.94 to distinguish adenomatous from nonadenomatous polyps. CONCLUSIONS: Ex vivo FuCM shows an excellent correlation with standard H&E for the diagnosis of colorectal polyps. The clinical direct benefit for patients, pathologists, and endoscopists allows adapting personalized surveillance protocols after colonoscopy and a workload decrease in pathology departments.