The Study On The Diagnostic Value Of Probe-based Confocal Laser Endomicroscopy In Early Gastric Cancer And Precancerous Lesions

ObjectiveTo explore the different manifestations of early gastric cancer(EGC)and gastric precancerous lesions(GPLs)under the probe-based confocal laser endomicroscopy(pCLE).To verify the diagnostic value of pCLE according to different stages of gastric mucosal lesion which including inflammation,atrophic gastritis,gastric intestinal metaplasia,gastric intraepithelial neoplasia as well as gastric cancer and to provide evidence-based medical support for its clinical application.MethodsWe screened patients who received pCLE examination in the endoscopy center of Gastroenterology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2013 to December 2019.The endoscopic diagnosis,histopathological results and surgical information of all patients were retrospectively analyzed to evaluate the diagnostic efficacy of white light endoscope(WLE)and pCLE on EGC / GPLs.Results1.Generally: A total of 187 patients and 438 gastric mucosal lesions were included in this study.The distribution of lesions mainly focused on the gastric antrum(50.23%)and the gastric angle(22.15%).2.The diagnosis on gastric mucosal lesions with pCLE and WLE: With the gold standard of biopsy histopathological diagnosis,the overall sensitivity(81.87%),specificity(80.62%)and accuracy(81.02%)of pCLE in the diagnosis of gastric mucosal lesions were significantly higher than WLE,of which the sensitivity,specificity and accuracy was 68.05%,68.44% and 68.32%,respectively.3.Comparison of diagnostic efficacy between pCLE and WLE: atrophic gastritis(AG),gastric intestinal metaplasia(GIM),and low-grade intraepit helial neoplasia(LGIN)were classified into gastric precancerous lesions,high-grade intraepithelial neoplasia(HGIN)and EGC were classified into cancerous lesions.pCLE was more sensitive than WLE in diagnosing of precancerous lesions(92.59% vs.52.59%)and cancerous lesions(84.21% vs.63.16%).The consistency between pCLE and histopathology was higher than that of WLE(Kappa = 0.641 vs.0.331)in diagnosing of precancerous lesions;The consistency of histopathology between pCLE and WLE was similar in diagnosing of cancerous lesions(Kappa = 0.573 vs.0.590).The area under the ROC curve(AUC = 0.809)for pCLE’s diagnosis of precancerous lesions was significantly higher than that for WLE(AUC = 0.725),P = 0.0198;While the area under the ROC curve for pCLE(AUC = 0.873)diagnosis of cancerous lesions was slightly higher than that for WLE(AUC = 0.795),P = 0.2068.4.INS evaluation: When predicting cancerous lesions,the sensitivity of INS(5-6 points)was significantly higher than that of INS(3-4 points)(100% vs.25.0%).5.Postoperative pathological diagnosis: There were 18 patients underwent endoscopic or surgical resection.Taking the postoperative pathological diagnosis as the gold standard,the diagnosis accuracy of pCLE(61.1%)was higher than that of biopsy histopathology(50.0%).It was difficult for pCLE to distinguish GIN from EGC,but it could reduce the underestimation of the disease severity to some extent.Conclusions1.pCLE improves the detection of EGC/ GPLs.The diagnosti c efficacy of pCLE was better than that of WLE when the gastric mucosal lesions were classified into 3 categories: inflammation,precancerous lesions(AG/ GIM/ LGIN),and cancerous lesions(HGIN/ EGC).2.It could effectively predict cancerous lesions of gastric mucosal when INS score ≥5.3.Although there was some difficulties for pCLE to distinguish GIN from EGC,it was better for pCLE than biopsy histopathology on the diagnosis of gastric mucosal lesions,which can reduce the underestimation of the disease severity.