Diagnostic accuracy of probe-based confocal laser endomicroscopy in detecting residual colorectal neoplasia after EMR

A prospective study

Muhammad W. Shahid, Anna M. Buchner, Emmanuel Coron, Timothy A. Woodward, Massimo Raimondo, Evelien Dekker, Paul Fockens, Michael B. Wallace

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background: Residual neoplasia after EMR of colorectal lesions is common. There is a critical need for imaging methods to accurately diagnose residual disease and to guide retreatment in real time. Objective: The aim was to estimate and compare the accuracy of virtual chromoendoscopy (VCE) and probe-based confocal laser endomicroscopy (pCLE) for detection of residual neoplastic tissue at the site of prior EMR. Design: Prospective, blind, pilot comparison of advanced endoscopic imaging (VCE and pCLE) by using matching histology as reference standard. Setting: Three tertiary-care referral hospitals. Patients: This study involved 92 participants who underwent follow-up colonoscopies for the evaluation of prior EMR sites within 1 year. Intervention: The EMR scars were assessed during follow-up high-resolution colonoscopy by using VCE (narrow-band imaging/Fujinon Intelligent Color Enhancement [FICE]), and pCLE. Confocal videos of EMR scars were interpreted in real time and were also stored and reviewed offline, blinded to histopathology and endoscopic appearance. Tissue confirmation by biopsies or polypectomy/repeat EMR was performed in all cases. Main Outcome Measurements: Sensitivity, specificity, and accuracy for VCE and pCLE alone and in combination against histopathology as the standard reference standard. Results: Among 129 EMR scars, residual neoplasia was confirmed by histology in 29 sites (22%). For VCE, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 72%, 77%, 49%, 91%, and 77%, respectively, and were 97%, 77%, 55%, 99%, and 81% for pCLE (P =.045 for sensitivity). When only EMR scars for which VCE and pCLE agreed on the diagnosis were analyzed (95/129 scars), the accuracy, sensitivity, specificity, PPV, and NPV of pCLE and VCE were 90%, 100%, 87%, 67%, and 100%, respectively. Limitations: Small sample size, lack of power, involvement of highly experienced pCLE experts. Conclusion: Confocal endomicroscopy significantly increases the sensitivity for detecting residual neoplasia after colorectal EMR compared with endoscopy alone. When confocal endomicroscopy is used in combination with VCE, the accuracy is extremely high, and sensitivity approaches that of histopathology. Together, they may reduce the need for histologic examination and allow a highly accurate on-table decision to treat again or not, thus avoiding unnecessary repeat procedures. (Clinical trial registration number: 00874263.)

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume75
Issue number3
DOIs
StatePublished - Mar 2012

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Lasers
Prospective Studies
Cicatrix
Neoplasms
Sensitivity and Specificity
Histology
Narrow Band Imaging
Computed Tomographic Colonography
Unnecessary Procedures
Retreatment
Tertiary Healthcare
Colonoscopy
Tertiary Care Centers
Sample Size
Endoscopy
Color
Clinical Trials
Biopsy

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Diagnostic accuracy of probe-based confocal laser endomicroscopy in detecting residual colorectal neoplasia after EMR : A prospective study. / Shahid, Muhammad W.; Buchner, Anna M.; Coron, Emmanuel; Woodward, Timothy A.; Raimondo, Massimo; Dekker, Evelien; Fockens, Paul; Wallace, Michael B.

In: Gastrointestinal Endoscopy, Vol. 75, No. 3, 03.2012.

Research output: Contribution to journalArticle

Shahid, Muhammad W. ; Buchner, Anna M. ; Coron, Emmanuel ; Woodward, Timothy A. ; Raimondo, Massimo ; Dekker, Evelien ; Fockens, Paul ; Wallace, Michael B. / Diagnostic accuracy of probe-based confocal laser endomicroscopy in detecting residual colorectal neoplasia after EMR : A prospective study. In: Gastrointestinal Endoscopy. 2012 ; Vol. 75, No. 3.
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abstract = "Background: Residual neoplasia after EMR of colorectal lesions is common. There is a critical need for imaging methods to accurately diagnose residual disease and to guide retreatment in real time. Objective: The aim was to estimate and compare the accuracy of virtual chromoendoscopy (VCE) and probe-based confocal laser endomicroscopy (pCLE) for detection of residual neoplastic tissue at the site of prior EMR. Design: Prospective, blind, pilot comparison of advanced endoscopic imaging (VCE and pCLE) by using matching histology as reference standard. Setting: Three tertiary-care referral hospitals. Patients: This study involved 92 participants who underwent follow-up colonoscopies for the evaluation of prior EMR sites within 1 year. Intervention: The EMR scars were assessed during follow-up high-resolution colonoscopy by using VCE (narrow-band imaging/Fujinon Intelligent Color Enhancement [FICE]), and pCLE. Confocal videos of EMR scars were interpreted in real time and were also stored and reviewed offline, blinded to histopathology and endoscopic appearance. Tissue confirmation by biopsies or polypectomy/repeat EMR was performed in all cases. Main Outcome Measurements: Sensitivity, specificity, and accuracy for VCE and pCLE alone and in combination against histopathology as the standard reference standard. Results: Among 129 EMR scars, residual neoplasia was confirmed by histology in 29 sites (22{\%}). For VCE, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 72{\%}, 77{\%}, 49{\%}, 91{\%}, and 77{\%}, respectively, and were 97{\%}, 77{\%}, 55{\%}, 99{\%}, and 81{\%} for pCLE (P =.045 for sensitivity). When only EMR scars for which VCE and pCLE agreed on the diagnosis were analyzed (95/129 scars), the accuracy, sensitivity, specificity, PPV, and NPV of pCLE and VCE were 90{\%}, 100{\%}, 87{\%}, 67{\%}, and 100{\%}, respectively. Limitations: Small sample size, lack of power, involvement of highly experienced pCLE experts. Conclusion: Confocal endomicroscopy significantly increases the sensitivity for detecting residual neoplasia after colorectal EMR compared with endoscopy alone. When confocal endomicroscopy is used in combination with VCE, the accuracy is extremely high, and sensitivity approaches that of histopathology. Together, they may reduce the need for histologic examination and allow a highly accurate on-table decision to treat again or not, thus avoiding unnecessary repeat procedures. (Clinical trial registration number: 00874263.)",
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T2 - A prospective study

AU - Shahid, Muhammad W.

AU - Buchner, Anna M.

AU - Coron, Emmanuel

AU - Woodward, Timothy A.

AU - Raimondo, Massimo

AU - Dekker, Evelien

AU - Fockens, Paul

AU - Wallace, Michael B.

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N2 - Background: Residual neoplasia after EMR of colorectal lesions is common. There is a critical need for imaging methods to accurately diagnose residual disease and to guide retreatment in real time. Objective: The aim was to estimate and compare the accuracy of virtual chromoendoscopy (VCE) and probe-based confocal laser endomicroscopy (pCLE) for detection of residual neoplastic tissue at the site of prior EMR. Design: Prospective, blind, pilot comparison of advanced endoscopic imaging (VCE and pCLE) by using matching histology as reference standard. Setting: Three tertiary-care referral hospitals. Patients: This study involved 92 participants who underwent follow-up colonoscopies for the evaluation of prior EMR sites within 1 year. Intervention: The EMR scars were assessed during follow-up high-resolution colonoscopy by using VCE (narrow-band imaging/Fujinon Intelligent Color Enhancement [FICE]), and pCLE. Confocal videos of EMR scars were interpreted in real time and were also stored and reviewed offline, blinded to histopathology and endoscopic appearance. Tissue confirmation by biopsies or polypectomy/repeat EMR was performed in all cases. Main Outcome Measurements: Sensitivity, specificity, and accuracy for VCE and pCLE alone and in combination against histopathology as the standard reference standard. Results: Among 129 EMR scars, residual neoplasia was confirmed by histology in 29 sites (22%). For VCE, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 72%, 77%, 49%, 91%, and 77%, respectively, and were 97%, 77%, 55%, 99%, and 81% for pCLE (P =.045 for sensitivity). When only EMR scars for which VCE and pCLE agreed on the diagnosis were analyzed (95/129 scars), the accuracy, sensitivity, specificity, PPV, and NPV of pCLE and VCE were 90%, 100%, 87%, 67%, and 100%, respectively. Limitations: Small sample size, lack of power, involvement of highly experienced pCLE experts. Conclusion: Confocal endomicroscopy significantly increases the sensitivity for detecting residual neoplasia after colorectal EMR compared with endoscopy alone. When confocal endomicroscopy is used in combination with VCE, the accuracy is extremely high, and sensitivity approaches that of histopathology. Together, they may reduce the need for histologic examination and allow a highly accurate on-table decision to treat again or not, thus avoiding unnecessary repeat procedures. (Clinical trial registration number: 00874263.)

AB - Background: Residual neoplasia after EMR of colorectal lesions is common. There is a critical need for imaging methods to accurately diagnose residual disease and to guide retreatment in real time. Objective: The aim was to estimate and compare the accuracy of virtual chromoendoscopy (VCE) and probe-based confocal laser endomicroscopy (pCLE) for detection of residual neoplastic tissue at the site of prior EMR. Design: Prospective, blind, pilot comparison of advanced endoscopic imaging (VCE and pCLE) by using matching histology as reference standard. Setting: Three tertiary-care referral hospitals. Patients: This study involved 92 participants who underwent follow-up colonoscopies for the evaluation of prior EMR sites within 1 year. Intervention: The EMR scars were assessed during follow-up high-resolution colonoscopy by using VCE (narrow-band imaging/Fujinon Intelligent Color Enhancement [FICE]), and pCLE. Confocal videos of EMR scars were interpreted in real time and were also stored and reviewed offline, blinded to histopathology and endoscopic appearance. Tissue confirmation by biopsies or polypectomy/repeat EMR was performed in all cases. Main Outcome Measurements: Sensitivity, specificity, and accuracy for VCE and pCLE alone and in combination against histopathology as the standard reference standard. Results: Among 129 EMR scars, residual neoplasia was confirmed by histology in 29 sites (22%). For VCE, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 72%, 77%, 49%, 91%, and 77%, respectively, and were 97%, 77%, 55%, 99%, and 81% for pCLE (P =.045 for sensitivity). When only EMR scars for which VCE and pCLE agreed on the diagnosis were analyzed (95/129 scars), the accuracy, sensitivity, specificity, PPV, and NPV of pCLE and VCE were 90%, 100%, 87%, 67%, and 100%, respectively. Limitations: Small sample size, lack of power, involvement of highly experienced pCLE experts. Conclusion: Confocal endomicroscopy significantly increases the sensitivity for detecting residual neoplasia after colorectal EMR compared with endoscopy alone. When confocal endomicroscopy is used in combination with VCE, the accuracy is extremely high, and sensitivity approaches that of histopathology. Together, they may reduce the need for histologic examination and allow a highly accurate on-table decision to treat again or not, thus avoiding unnecessary repeat procedures. (Clinical trial registration number: 00874263.)

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