Improved classification of indeterminate biliary strictures by probe-based confocal laser endomicroscopy using the Paris Criteria following biliary stenting

2017 ◽  
Vol 32 (10) ◽  
pp. 1778-1783 ◽  
Author(s):  
Pushpak Taunk ◽  
Satish Singh ◽  
David Lichtenstein ◽  
Virendra Joshi ◽  
Jason Gold ◽  
...  
Keyword(s):  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Stenting ◽  
Biliary Strictures

scholarly journals Probe-Based Confocal Laser Endomicroscopy for Indeterminate Biliary Strictures: Refinement of the Image Interpretation Classification

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Michel Kahaleh ◽  
Marc Giovannini ◽  
Priya Jamidar ◽  
S. Ian Gan ◽  
Paola Cesaro ◽  
...  
Keyword(s):  
Prospective Study ◽  
Interobserver Agreement ◽  
Image Interpretation ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Strictures ◽  
Inflammatory Conditions ◽  
Paris Classification ◽  
Low Sensitivity ◽  
Duct Stricture

Background. Accurate diagnosis and clinical management of indeterminate biliary strictures are often a challenge. Tissue confirmation modalities during Endoscopic Retrograde Cholangiopancreatography (ERCP) suffer from low sensitivity and poor diagnostic accuracy. Probe-based confocal laser endomicroscopy (pCLE) has been shown to be sensitive for malignant strictures characterization (98%) but lacks specificity (67%) due to inflammatory conditions inducing false positives.Methods. Six pCLE experts validated the Paris Classification, designed for diagnosing inflammatory biliary strictures, using a set of 40 pCLE sequences obtained during the prospective registry (19 inflammatory, 6 benign, and 15 malignant). The 4 criteria used included (1) multiple thin white bands, (2) dark granular pattern with scales, (3) increased space between scales, and (4) thickened reticular structures. Interobserver agreement was further calculated on a separate set of 18 pCLE sequences.Results. Overall accuracy was 82.5% (n=40retrospectively diagnosed) versus 81% (n=89prospectively collected) for the registry, resulting in a sensitivity of 81.2% (versus 98% for the prospective study) and a specificity of 83.3% (versus 67% for the prospective study). The corresponding interobserver agreement for 18 pCLE clips was fair (k=0.37).Conclusion. Specificity of pCLE using the Paris Classification for the characterization of indeterminate bile duct stricture was increased, without impacting the overall accuracy.

scholarly journals Emerging Technologies for the Diagnosis of Perihilar Cholangiocarcinoma

2018 ◽  
Vol 38 (02) ◽  
pp. 160-169 ◽  
Author(s):  
Sumera Rizvi ◽  
John Eaton ◽  
Ju Dong Yang ◽  
Vinay Chandrasekhara ◽  
Gregory Gores
Keyword(s):  
Emerging Technologies ◽  
High Specificity ◽  
Biliary Tree ◽  
Extracellular Vesicle ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Strictures ◽  
Conventional Cytology ◽  
Special Expertise

AbstractThe diagnosis of malignant biliary strictures remains problematic, especially in the perihilar region and in primary sclerosing cholangitis (PSC). Conventional cytology obtained during endoscopic retrograde cholangiography (ERC)-guided brushings of biliary strictures is suboptimal due to limited sensitivity, albeit it remains the gold standard with a high specificity. Emerging technologies are being developed and validated to address this pressing unmet patient need. Such technologies include enhanced visualization of the biliary tree by cholangioscopy, intraductal ultrasound, and confocal laser endomicroscopy. Conventional cytology can be aided by employing complementary and advanced cytologic techniques such as fluorescent in situ hybridization (FISH), and this technique should be widely adapted. Interrogation of bile and serum by examining extracellular vesicle number and cargo, and exploiting next-generation sequencing and proteomic technologies, is also being explored. Examination of circulating cell-free deoxyribonucleic acid (cfDNA) for differentially methylated regions is a promising test which is being rigorously validated. The special expertise required for these analyses has to date hampered their validation and adaptation. Herein, we will review these emerging technologies to inform the reader of the progress made and encourage further studies, as well as adaptation of validated approaches.

scholarly journals Diagnostic utility of probe-based confocal laser endomicroscopy in superficial non-ampullary duodenal epithelial tumors

2019 ◽  
Vol 07 (11) ◽  
pp. E1515-E1521
Author(s):  
Tomomitsu Tahara ◽  
Noriyuki Horiguchi ◽  
Tsuyoshi Terada ◽  
Hyuga Yamada ◽  
Dai Yoshida ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Duodenal Mucosa ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Observational Trial ◽  
Histological Features ◽  
Epithelial Tumors ◽  
Neoplastic Lesions ◽  
Columnar Cells

Abstract Background and study aims Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors (SNADETs) has not been established. Probe-based confocal laser endomicroscopy (pCLE: Cellvizio) provides real-time endomicroscopic analysis. We developed and validated a new pCLE classification of SNADET based on abnormal findings. Patients and methods pCLE scanning of 20 SNADET lesions including 16 adenomas and four carcinomas was retrospectively evaluated to explore abnormal pCLE findings in relation to histological features. Diagnostic yield of pCLE findings was prospectively evaluated in an additional 20 SNADET lesions including 16 adenomas and four carcinomas. Results In a retrospective study, we identified four abnormal pCLE findings of SNADETs: (1) dark epithelium, (2) columnar cells irregularly extending to the lumen, (3) distorted crypt structure, and (4) fluorescein leakage. Dark epithelium distinguished neoplastic lesions (adenomas and carcinomas) from non-neoplastic duodenal mucosa with a sensitivity of 90 % and a specificity of 100 %. Distorted crypt structure distinguished carcinomas from adenomas and non-neoplastic duodenal mucosa with a sensitivity of 100% and a specificity of 94 %. In the prospective study, the sensitivity and the specificity of the dark epithelium for the diagnosis of neoplastic lesions (adenomas + carcinomas) was 75% and 100 %. Sensitivity and the specificity of the distorted crypt structure for discrimination of carcinoma from adenoma were 100 % and 94 %, respectively. Conclusions The pCLE findings correlated with the histopathology of the SNADETs. Dark epithelium and distorted crypt structure were informative pCLE findings to predict presence of neoplasia and cancer in the SNADET, respectively.UMIN-CTR UMIN000013857 TRIAL REGISTRATION: Single-Center, prospective observational trial UMIN000013857 at upload.umin.ac.jp

Classification of Inflammation Activity in Ulcerative Colitis by Confocal Laser Endomicroscopy

2010 ◽  
Vol 105 (6) ◽  
pp. 1391-1396 ◽  
Author(s):  
Chang-Qing Li ◽  
Xiang-Jun Xie ◽  
Tao Yu ◽  
Xiao-Meng Gu ◽  
Xiu-Li Zuo ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser

Interobserver Agreement in the Classification of Pancreatic Cysts With Needle-Based Confocal Laser Endomicroscopy

2015 ◽  
Vol 110 ◽  
pp. S27-S28
Author(s):  
Shivani Gupta ◽  
Lauren Khanna ◽  
Ashish R. Shah ◽  
John Poneros ◽  
Tamas A. Gonda ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Pancreatic Cysts

Classification of probe-based confocal laser endomicroscopy findings in pancreaticobiliary strictures

Endoscopy ◽  
2012 ◽  
Vol 44 (03) ◽  
pp. 251-257 ◽  
Author(s):  
A. Meining ◽  
R. Shah ◽  
A. Slivka ◽  
D. Pleskow ◽  
R. Chuttani ◽  
...  
Keyword(s):  
Confocal Laser Endomicroscopy ◽  
Confocal Laser
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