Background and study aims: A recently developed probe-based, confocal laser endomicroscopy (pCLE) system provides
images of surface colonic epithelium in vivo during any endoscopy. Our objective was
to assess interobserver agreement, sensitivity, specificity, and overall accuracy
in the diagnosis of neoplasia using pCLE.
Patients and methods: 53 patients undergoing surveillance and screening colonoscopies were enrolled. A
total of 75 lesions, were detected and all were inspected by pCLE prior to sampling
or polypectomy. Intravenous fluorescein was used to optimize tissue contrast. Three
pCLE users, blinded to histopathologic and endoscopic findings, reviewed the set of
video sequences for crypt architecture, vessel architecture, and colorectal neoplasia
diagnosis. Histopathologic diagnosis from the corresponding biopsies was the reference
gold standard.
Results: Of the 75 colorectal lesions, 50 were neoplastic and 25 non-neoplastic. Interobserver
agreement was moderate to good for the classification of neoplasia (kappa 0.55, 78 %
pairwise agreement), and moderate for vessel architecture (kappa 0.41, 67 % pairwise
agreement) and crypt architecture (kappa 0.49, 69 % pairwise agreement). In distinguishing
between neoplastic and non-neoplastic lesions, sensitivity, specificity, and accuracy
were 76 %, 72 % and 75 %, respectively. When videos of good or excellent quality only
were considered, interobserver agreement for classification of neoplasia was higher
(kappa 0.83, 92 % pairwise agreement), as were sensitivity (88 %), specificity (89 %),
and accuracy (88 %).
Conclusion: An international collaboration group had moderate to good interobserver agreement
using a pCLE system to predict neoplasia, which is acceptable for this study.
References
wallace.michael@mayo.edu
