Z Gastroenterol 2013; 51 - A7
DOI: 10.1055/s-0033-1347382

A pilot study of confocal laser endomicrosopy for staging and follow-up of gastrointestinal MALT-lymphoma: interim analysis of 15 consecutive cases

W Dolak 1, B Kiesewetter 2, L Müllauer 3, A Chott 4, M Trauner 1, M Raderer 2, A Püspök 1
  • 1Medical University Vienna, Internal Medicine III, Gastroenterology and Hepatology, Vienna, Austria
  • 2Medical University Vienna, Internal Medicine I, Oncology, Vienna, Austria
  • 3Medical University Vienna, Pathology, Vienna, Austria
  • 4Wilhelminenspital, Pathology, Vienna, Austria

Introduction: To improve the diagnostic yield for gastrointestinal (GI) MALT-lymphoma during staging and follow-up, we investigated the diagnostic role of confocal laser endomicroscopy (CLE) which provides in-vivo histology of gastrointestinal diseases.

Methods: In the context of a prospective clinical pilot trial (NCT01583699) all patients referred to our department for staging or follow-up of suspected upper-GI MALT-lymphoma underwent endosonography (EUS) followed by upper-GI endoscopy using a CLE-colonoscope. CLE-examinations were performed by one single endoscopist with great experience in CLE, blinded to the result of prior EUS or previous endoscopic results. The CLE-scope was introduced in a push-enteroscopic manner till the deep jejunum. 4-quadrant CLE-pictures and conventional biopsies were taken randomly during withdrawal from each segment, in addition to CLE-pictures and biopsies of distinct looking areas. At the end of each examination, a preliminary diagnosis based on the CLE-pictures was set. This was later compared to the histological result.

Results: At an interim analysis a total of 15 patients (8 male, 7 female, median age 68 years, range 35 to 77 years) had been studied. Histological assessment of conventional biopsies taken during the study revealed MALT-lymphoma of the stomach and duodenum in 8 and 2 patients, respectively. In 6 patients no MALT-lymphoma was found. Compared to histology, the sensitivity of EUS, white light endoscopy and CLE for MALT-lymphoma was 56%, 78% and 88%, the specificity was 83%, 83% and 100%, respectively. In those cases where MALT-lymphoma presence was missed by CLE, infiltration of lymphoma cells was limited to deeper wall layers that could not be assessed by CLE.

Conclusions: The preliminary results of this first prospective study on the diagnostic role of confocal laser endomicroscopy in GI MALT-lymphoma showed a promising clinical value of this new endoscopic method. Current drawbacks like the limited tissue penetration might be overcome by future technical improvements.