Clin Endosc.  2019 Mar;52(2):144-151. 10.5946/ce.2018.091.

Bimodal Chromoendoscopy with Confocal Laser Endomicroscopy for the Detection of Early Esophageal Squamous Cell Neoplasms

• Prueksapanich P
• Luangsukrerk T
• Pittayanon R
• Sanpavat A
• Rerknimitr R

• KMID: 2447671
• DOI: http://doi.org/10.5946/ce.2018.091

Abstract

BACKGROUND/AIMS
This study aimed to evaluate the diagnostic accuracy of dual-focus narrow-band imaging (dNBI) and Lugol'schromoendoscopy (LCE) combined with probe-based confocal laser endomicroscopy (pCLE) to screen for esophageal squamous cell neoplasms (ESCNs) in patients with a history of head and neck cancer.
METHODS
From March to August 2016, dNBI was performed. Next, LCE was performed, followed by pCLE and biopsy. Histology has historically been the gold standard to diagnose ESCN. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of dNBI and LCE adjunct with pCLE were determined.
RESULTS
Twenty-four patients were included. Ten ESCNs were found in 8 patients (33%). Forty percent of high-graded intraepithelial neoplasias and all low-grade intraepithelial neoplasias were overlooked by dNBI. The sensitivity, specificity, PPV, NPV, and accuracy of dNBI vs. LCE combined with pCLE were 50% vs. 80%, 62% vs. 67%, 36% vs. 44%, 75% vs. 91%, and 83% vs. 70%, respectively.
CONCLUSIONS
The use of dNBI to detect ESCN was suboptimal. LCE with pCLE following dNBI had additional value for detecting esophageal dysplasia not detected by dNBI. The use of pCLE to detect dNBI-missed lesions yielded a high NPV, while pCLE-guided biopsy could reduce the number of unnecessary biopsies.

Keyword

Narrow-band imaging; Lugol's chromoendoscopy; Probe-based confocal laser endomicroscopy; Early esophageal squamous cell neoplasm

MeSH Terms

Biopsy
Epithelial Cells*
Head and Neck Neoplasms
Humans
Neoplasms, Squamous Cell*
Sensitivity and Specificity

Figure

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  Fig. 1. Near focus view of dual-focus narrow-band imaging (dNBI) of normal esophageal mucosa showing a normal intrapapillary capillary loop (IPCL) pattern (A). The near focus view of dNBI of high-grade intraepithelial neoplasia shows a well-demarcated brownish area with dilated, tortuous, and various shapes of IPCL (B).

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  Fig. 2. The probe-based confocal laser endomicroscopy (pCLE) findings of normal esophageal mucosa and esophageal squamous cell neoplasms. For normal esophageal mucosa, pCLE shows a homogenous, regular architecture, clearly visible cell borders (A), and regular capillaries without fluorescein leakage (B). For low-grade intraepithelial neoplasia, pCLE shows a slightly inhomogeneous, irregular architecture, clearly visible cell borders (C), and regular capillaries without fluorescein leakage (D). For high-grade intraepithelial neoplasia, pCLE shows an inhomogeneous and irregular cellular architecture without clearly visible cell borders (E) and irregular, twisted, dilated, elongated capillaries (F) with fluorescein leakage (F, arrows).

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  Fig. 3. Flow chart of the studied patients. dNBI, dual-focus narrow-band imaging; ESCN, esophageal squamous cell neoplasm; HGIN, high-grade intraepithelial neoplasia; LCE, Lugol’s chromoendoscopy; LGIN, low-grade intraepithelial neoplasia; LVL, Lugol’s voiding lesion; pCLE, probe-based confocal laser endomicroscopy; SCC, squamous cell carcinoma.

• 

  Fig. 4. Squamous cell cancer detected by white-light endoscopy showing a nodular surface with dilated neoplastic vessels.

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