Diagnostic Value Of Confocal Laser Endomicroscopy In Early Esophageal Squamous Cell Carcinoma And Precancerous Lesions

Background and aimsSquamous cell carcinoma of the esophagus is a common malignant tumour, is the sixth leading cause of death from cancer in worldwide. Although esophageal adenocarcinoma rates is increasing, squamous cell carcinoma rates is decreasing esophageal squamous cell carcinoma is still a common type in china. When the patients were diagnosised as esophageal cancer, most of cases are already in an advanced stage. It is the key to improve the prognosis that the early diagnosis of esophageal neoplasms. Lugol's solution is widely used for the diagnosis of early esophageal squamous cell cancer.Iodine staining for early esophageal squamous cell cancer have a high sensitivity, but a low specificity. The aim of this study was to assess the diagnostic value of confocal laser endomicroscopy (CLE) in diagnosis of early esophageal squamous cell carcinoma and precancerous lesions in vivo.MethodCLE examination was performed in 41 patients who need further examination or surveillance because of lesions in esophagus during July 2008 to April 2009.The features of esophageal squamous cell low grade intraepithelial neoplasia(LGIN), the feature of high grade intraepithelial neoplasia (HGIN) and early esophageal squamous cell carcinoma (EC) were defined, and in vivo diagnosis was performed during ongoing endoscopy. Biopsy specimens were taken precisely matched to the CLE imaging sites. The diagnostic results of histopathology and CLE were compared.ResultsIn total,7281 confocal images were obtained from 60 target lesions in 41 patients. The sensitivity,specificity, the positive predictive value,the negative predictive value and accuracy of CLE in diagnosis of LGIN were 75.0%,88.6%,70.6%,90.7% and 85.0%, in diagnosis of HGIN were 85.7%,92.3%,85.7%,92.3% and 90.0%, respectively. The sensitivity,specificity, the positive predictive value,the negative predictive value and accuracy of CLE in diagnosis of EC were 88.9%,96.1%,80.0%,98.0% and 95.0%, respectively.Conclusionconfocal laser endomicroscopy (CLE) effectively discriminates esophageal neoplastic lesions from non-neoplastic lesions, is able to diagnose high grade intraepithelial neoplasia and early cancer with a high degree of accuracy.Significanceconfocal laser endomicroscopy(CLE) is a novel diagnostic technique that provide in vivo virtual histology image of the gastrointestinal mucosa during ongoing endoscopy,which can guide for target biopsy.This study show that CLE can present the characteristic of esophageal neoplasm and normal squamous cell epithelium clearly, which provide a new way for the early diagnosis of esophageal neoplasm.