Brief Article
Copyright ©2012 Baishideng. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2012; 4(9): 414-420
Published online Sep 16, 2012. doi: 10.4253/wjge.v4.i9.414
Diagnostic accuracy of confocal laser endomicroscopy in diagnosing dysplasia in patients affected by long-standing ulcerative colitis
Antonio Rispo, Fabiana Castiglione, Stefania Staibano, Dario Esposito, Francesco Maione, Maria Siano, Francesca Salvatori, Stefania Masone, Marcello Persico, Giovanni Domenico De Palma
Antonio Rispo, Fabiana Castiglione, Gastroenterology, University “Federico II” of Naples, 80131 Naples, Italy
Stefania Staibano, Maria Siano, Department of Biomorphological and Functional Sciences, Section of Pathology, University “Federico II” of Naples, 80131 Naples, Italy
Dario Esposito, Francesco Maione, Francesca Salvatori, Stefania Masone, Marcello Persico, Giovanni Domenico De Palma, Surgery and Advanced Technologies-University “Federico II” of Naples, 80131 Naples, Italy
Author contributions: Rispo A, Castiglione F and De Palma GD designed the study, selected all UC patients and followed them up; De Palma GD, Maione F and Rispo A performed all the endoscopies; De Palma GD and Esposito D performed the CLE evaluation; Staibano S and Siano M performed the histological examinations; Masone S and Persico M performed the surgical procedures; Salvatori F analyzed all the data.
Correspondence to: Antonio Rispo, MD, Gastroenterology, University “Federico II” of Naples, Facoltà di Medicina e Chirurgia, Via S. Pansini 5, 80131 Naples, Italy. antoniorispo@email.it
Telephone: +39-81-7463849 Fax: +39-81-5465649
Received: December 13, 2011
Revised: June 4, 2012
Accepted: September 12, 2012
Published online: September 16, 2012
Abstract

AIM: To evaluate the diagnostic accuracy of confocal laser endomicroscopy (CLE) for the detection of dysplasia in long-standing ulcerative colitis (UC).

METHODS: We prospectively performed a surveillance colonoscopy in 51 patients affected by long-standing UC. Also, in the presence of macroscopic areas with suspected dysplasia, both targeted contrasted indigo carmine endoscopic assessment and probe-based CLE were performed. Colic mucosal biopsies and histology, utilised as the gold standard, were assessed randomly and on visible lesions, in accordance with current guidelines.

RESULTS: Fourteen of the 51 patients (27%) showed macroscopic mucosal alterations with the suspected presence of dysplasia, needing chromoendoscopic and CLE evaluation. In 5 macroscopically suspected cases, the presence of dysplasia was confirmed by histology (3 flat dysplasia; 2 DALMs). No dysplasia/cancer was found on any of the outstanding random biopsies. The diagnostic accuracy of CLE for the detection of dysplasia compared to standard histology was sensitivity 100%, specificity 90%, positive predictive value 83% and negative predictive value 100%.

CONCLUSION: CLE is an accurate tool for the detection of dysplasia in long-standing UC and shows optimal values of sensitivity and negative predictivity. The scheduled combined application of chromoendoscopy and CLE could maximize the endoscopic diagnostic accuracy for diagnosis of dysplasia in UC patients, thus limiting the need for biopsies.

Keywords: Ulcerative colitis; Cancer; Confocal; Surveillance