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Endoscopic ultrasound‐guided needle‐based confocal laser endomicroscopy in gastrointestinal subepithelial lesions: Feasibility study
Author(s) -
Terada Tsuyoshi,
Tahara Tomomitsu,
Hashimoto Senju,
Horiguchi Noriyuki,
Funasaka Kohei,
Nagasaka Mitsuo,
Nakagawa Yoshihito,
Shibata Tomoyuki,
Yoshioka Kentaro,
Tsukamoto Tetsuya,
Kuroda Makoto,
Ohmiya Naoki
Publication year - 2020
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13542
Subject(s) - medicine , radiology , concordance , endoscopic ultrasound , fine needle aspiration , leiomyoma , biopsy , pathology
Background and Aim Needle‐based confocal laser endomicroscopy (nCLE) allows for real‐time optical biopsies during endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA). Little is known about nCLE imaging of gastrointestinal subepithelial lesions (GI‐SEL); therefore, we determined its feasibility. Methods We carried out EUS, nCLE, and finally FNA in 25 patients with GI‐SEL between November 2015 and December 2018. We retrospectively compared nCLE findings with pathological findings of EUS‐FNA or surgical specimens. For concordance analysis, two endoscopists independently validated representative nCLE images 5 months or more after examinations. Results Adequate sample acquisition rate of EUS‐FNA was 67% per needle pass and 96% per patient. EUS‐FNA was diagnostic in 80% (20/25), suspicious in 4% (1/25), and nondiagnostic in 16% (4/25). nCLE image acquisition rate was 100% and its concordance rate with final pathology was 88% (22/25), which was not significantly different from diagnostic and suspicious EUS‐FNA. nCLE could differentiate GI stromal tumors (GISTs) from leiomyoma, in that GISTs were characterized by contrast‐enhanced densely populated spindle cell tumors with unenhanced rod‐shaped nuclei in 93% of 14 patients, whereas leiomyomas were characterized by narrower spindle cell tumors with fewer and smaller unenhanced nuclei in 100% of three patients. In rectal metastasis from lung adenocarcinoma, some pleomorphic dark nests were observed. At concordance analysis between the two endoscopists’ validation results, κ value was 0.560 ( P < 0.001), indicating moderate agreement. There were no adverse events associated with nCLE and EUS‐FNA. Conclusion Needle‐based confocal laser endomicroscopy can be safe and useful for on‐site detection of abnormalities of GI‐SEL (UMIN 000013857).