Confocal laser endomicroscopy under propofol‐based sedation for early gastric cancer and pre‐cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China

Abstract Background Confocal laser endomicroscopy (CLE) has advantages in detecting gastric neoplastic lesions, meanwhile it requires strict patient cooperation. Sedation could improve patient cooperation and quality of endoscopy. However, sedation is still not very popular in some resource-limited countries and regions. The purpose of this study was to compare propofol-based sedated versus un-sedated CLE in the value of diagnosing early gastric cancer (EGC) and precancerous lesions. Methods A retrospective, cohort, single center study of 226 patients who underwent CLE between January 1, 2015 and December 31, 2017 was performed. Patients enrolled were allocated into the propofol-based sedated group (n = 126) and the un-sedated group (n = 100). The comparison of validity and reliability of CLE for identifying EGC and precancerous lesions between the two groups was performed through analyzing CLE diagnosis and pathological diagnosis. Reporting followed the STROBE guidelines. Results The area under receiver operating characteristic curve (AUROC) of diagnosing EGC in the sedated group was 0.97 (95 % CI: 0.95 to 0.99), which was higher than that in the un-sedated group (0.88 (95 % CI: 0.80 to 0.97), P = 0.0407). CLE with sedation performed better than without sedation in diagnosing intraepithelial neoplasia and intestinal metaplasia (P = 0.0008 and P = 0.0001, respectively). For patients considered as high-grade intraepithelial neoplasia or EGC by endoscopists, they would not get biopsy during CLE but receive endoscopic submucosal dissection (ESD) subsequently, and the misdiagnosis rate of CLE was 0 % in the sedated group and 27.59 % (95 % CI: 10.30–44.91 %) in the un-sedated group (P = 0.006). Conclusions Propofol based sedation was associated with improved diagnostic value of CLE for detecting EGC as well as precancerous lesions (intraepithelial neoplasia OR intestinal metaplasia).

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Confocal laser endomicroscopy under propofol-based sedation for early gastric cancer and pre-cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China

10.21203/rs.3.rs-41225/v3 ◽

2020 ◽

Author(s):

Lihua Chu ◽

Jialian Zhao ◽

Cheng Sheng ◽

Min Yue ◽

Feifei Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Intestinal Metaplasia ◽

Retrospective Cohort ◽

Precancerous Lesions ◽

Characteristic Curve ◽

Intraepithelial Neoplasia ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Patient Cooperation

Abstract Background: Confocal laser endomicroscopy (CLE) has advantages in detecting gastric neoplastic lesions, meanwhile it requires strict patient cooperation. Sedation could improve patient cooperation and quality of endoscopy. However, sedation is still not very popular in some resource-limited countries and regions. The purpose of this study was to compare propofol-based sedated versus un-sedated CLE in the value of diagnosing early gastric cancer (EGC) and precancerous lesions.Methods: A retrospective, cohort, single center study of 226 patients who underwent CLE between January 1, 2015 and December 31, 2017 was performed. Patients enrolled were allocated into the propofol-based sedated group (n=126) and the un-sedated group (n=100). The comparison of validity and reliability of CLE for identifying EGC and precancerous lesions between the two groups was performed through analyzing CLE diagnosis and pathological diagnosis. Reporting followed the STROBE guidelines.Results: The area under receiver operating characteristic curve (AUROC) of diagnosing EGC in the sedated group was 0.97 (95% CI: 0.95 to 0.99), which was higher than that in the un-sedated group (0.88 (95% CI: 0.80 to 0.97), P =0.0407). CLE with sedation performed better than without sedation in diagnosing intraepithelial neoplasia and intestinal metaplasia (P =0.0008 and P =0.0001, respectively). Conclusion: Propofol based sedation was associated with improved diagnostic value of CLE for detecting EGC as well as precancerous lesions (intraepithelial neoplasia OR intestinal metaplasia).

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Confocal laser endomicroscopy under propofol-based sedation for early gastric cancer and pre-cancerous lesions is associated with better diagnosing accuracy: a retrospective cohort study in China

10.21203/rs.3.rs-41225/v1 ◽

2020 ◽

Author(s):

Lihua Chu ◽

Jialian Zhao ◽

Cheng Sheng ◽

Min Yue ◽

Feifei Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Retrospective Cohort ◽

Precancerous Lesions ◽

Characteristic Curve ◽

Intraepithelial Neoplasia ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Validity And Reliability ◽

Patient Cooperation

Abstract Background: Confocal laser endomicroscopy (CLE) has advantages in detecting gastric neoplastic lesions, meanwhile it requires strict patient cooperation. Sedation could improve patient cooperation and quality of endoscopy. However, sedation is still not very popular in some resource-limited countries and regions. The purpose of this study was to compare propofol-based sedated versus un-sedated CLE in the value of diagnosing early gastric cancer (EGC) and precancerous lesions.Methods: A retrospective, cohort, single center study of 226 patients who underwent CLE between January 1, 2015 and December 31, 2017 was performed.Patients enrolled were allocated into propofol-based sedated group (n=126) and un-sedated group (n=100). The comparison of validity and reliability of CLE for identifying EGC and precancerous lesions between the two groups was performed through analyzing CLE diagnose and pathological diagnose. Results: The area under receiver operating characteristic curve (AUROC) of diagnosing EGC in sedated group was 0.97 (95% CI: 0.95 to 0.99), which was higher than that in un-sedated group (0.88 (95% CI: 0.80 to 0.97), P =0.0407). CLE with sedation performed better than without sedation in diagnosing intraepithelial neoplasia and intestinal metaplasia (P =0.0008 and P =0.0084, respectively). For patients considered as high-grade intraepithelial neoplasia or EGC by endoscopists, they would not get biopsy during CLE but receive ESD subsequently, and the misdiagnosis rate of CLE was 0 in sedated group and 27.59% in un-sedated group (P =0.006).Conclusion: Propofol based sedation was associated with improved diagnostic value of CLE for detecting EGC as well as precancerous lesions.

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Confocal laser endomicroscopy under propofol-based sedation for early gastric cancer and pre-cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China

10.21203/rs.3.rs-41225/v2 ◽

2020 ◽

Author(s):

Lihua Chu ◽

Jialian Zhao ◽

Cheng Sheng ◽

Min Yue ◽

Feifei Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Retrospective Cohort ◽

Precancerous Lesions ◽

Characteristic Curve ◽

Intraepithelial Neoplasia ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Validity And Reliability ◽

Patient Cooperation

Abstract Background: Confocal laser endomicroscopy (CLE) has advantages in detecting gastric neoplastic lesions, meanwhile it requires strict patient cooperation. Sedation could improve patient cooperation and quality of endoscopy. However, sedation is still not very popular in some resource-limited countries and regions. The purpose of this study was to compare propofol-based sedated versus un-sedated CLE in the value of diagnosing early gastric cancer (EGC) and precancerous lesions.Methods: A retrospective, cohort, single center study of 226 patients who underwent CLE between January 1, 2015 and December 31, 2017 was performed.Patients enrolled were allocated into the propofol-based sedated group (n=126) and the un-sedated group (n=100). The comparison of validity and reliability of CLE for identifying EGC and precancerous lesions between the two groups was performed through analyzing CLE diagnosis and pathological diagnosis. Reporting followed the STROBE guidelines.Results: The area under receiver operating characteristic curve (AUROC) of diagnosing EGC in the sedated group was 0.97 (95% CI: 0.95 to 0.99), which was higher than that in the un-sedated group (0.88 (95% CI: 0.80 to 0.97), P =0.0407). CLE with sedation performed better than without sedation in diagnosing intraepithelial neoplasia and intestinal metaplasia (P =0.0008 and P =0.0084, respectively). For patients considered as high-grade intraepithelial neoplasia or EGC by endoscopists, they would not get biopsy during CLE but receive endoscopic submucosal dissection (ESD) subsequently, and the misdiagnosis rate of CLE was 0% in the sedated group and 27.59% in the un-sedated group (P =0.006).Conclusion: Propofol based sedation was associated with improved diagnostic value of CLE for detecting EGC as well as precancerous lesions.

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Endoscopic molecular imaging of early gastric cancer targeting transferrin receptor 1.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e23093 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e23093-e23093

Author(s):

Jie Tian ◽

Yang Du

Keyword(s):

Gastric Cancer ◽

Molecular Imaging ◽

Early Gastric Cancer ◽

Diagnostic Accuracy ◽

Transferrin Receptor ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Human Gastric Cancer ◽

Transferrin Receptor 1

e23093 Background: Gastric cancer is primarily managed endoscopically by white light gastroscope with suboptimal diagnostic accuracy. Emerging optical imaging technologies possess great potential for improving diagnostic accuracy but currently lack imaging agents for molecular specificity. In this study, a novel ligand of transferrin receptor 1 (TfR1), human H-ferritin (HFn), was labeled with fluorescent agents to enable in vivo real-time imaging by confocal laser endomicroscopy (CLE). Methods: In vivo fluorescence imaging was performed in tumor-bearing mice from human gastric cancer cell lines using fluorescently labeled HFn nanoprobe. The HFn-FITC as molecular imaging agent was applied to the gastric cancer with confocal laser endomicroscopy (CLE) in fresh endoscopic submucosal dissection (ESD) of early gastric cancer. Results: Intravital imaging of gastric xenograft tumors revealed a specific tumor targeting effects of HFn-IRDye800CW, whereas no specific signal was observed in mice injected with free dye. An ex vivo experiment on human specimens using a rigid confocal probe showed positive fluorescent staining in ESD samples diagnosed as early gastric cancers. Our CLE evaluation correlated well with immunohistochemical findings. Conclusions: CLE can be used for in vivo, molecular analysis of early gastric cancer and to identify TfR1 expression in xenografts and human tissue samples. HFn-targeted molecular imaging could improve early detection of gastric cancer.

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The diagnostic value of confocal laser endomicroscopy for gastric cancer and precancerous lesions among Asian population: a system review and meta-analysis

Scandinavian Journal of Gastroenterology ◽

10.1080/00365521.2016.1275770 ◽

2017 ◽

Vol 52 (4) ◽

pp. 382-388 ◽

Cited By ~ 8

Author(s):

Hai-Ping Zhang ◽

Sheng Yang ◽

Wen-Hua Chen ◽

Teng-Teng Hu ◽

Jun Lin

Keyword(s):

Gastric Cancer ◽

Precancerous Lesions ◽

Meta Analysis ◽

Asian Population ◽

Diagnostic Value ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

System Review

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Expression of Oncostatin M in Early Gastric Cancer and Precancerous Lesions

Gastroenterology Research and Practice ◽

10.1155/2019/3616140 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Jihua Shi ◽

Xue Xu ◽

Jun Du ◽

Haimeng Cui ◽

Qingfeng Luo

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Chronic Gastritis ◽

Precancerous Lesions ◽

Intraepithelial Neoplasia ◽

Oncostatin M ◽

Low Grade ◽

Mucosal Epithelium ◽

Expression Levels ◽

Significant Difference

Objective. To detect the expression of the Oncostatin M (OSM) gene and encoded protein in the mucosal epithelium of chronic gastritis, intestinal metaplasia (IM), low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), early gastric cancer (EGC), and advanced gastric cancer (AGC) samples and to explore the correlation and clinicopathological significance of OSM expression in the process of gastric carcinogenesis. Methods. The expression levels of OSM in chronic gastritis, IM, LGIN, HGIN, EGC, and AGC samples were detected by gene chip, real-time quantitative PCR, and immunohistochemical methods. The expression levels of OSM in the gastric mucosa were analyzed, and its correlation with clinical pathology was studied. Results. The expression level of OSM in gastric HGIN and EGC tissues was significantly higher than that in LGIN tissues based on expression profiling (P<0.001). The expression of the OSM gene in EGC was higher than that in HGIN (unpaired t test, P<0.05) and LGIN (unpaired t test, P<0.01) by qPCR. The expression of OSM in LGIN was significantly lower than that in HGIN (P=0.008) and EGC (P=0.044) by immunohistochemical staining. The expression of OSM in HGIN tissues was significantly higher than that in AGC (P=0.007). Conclusion. Alterations in the expression of the OSM gene may be involved in the malignant transformation of the gastric mucosal epithelium. Because of the significant difference in the cancerization rate and clinical management between LGIN and HGIN, the difference in the staining intensity of OSM between LGIN and HGIN may be one of the early markers of gastric intraepithelial neoplasia.

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Sa1221 ENDOSCOPIC MOLECULAR IMAGING OF EARLY GASTRIC CANCER USING HUMAN HEAVY-CHAIN FERRITIN NANOPROBE UNDER CONFOCAL LASER ENDOMICROSCOPY

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2018.04.1422 ◽

2018 ◽

Vol 87 (6) ◽

pp. AB169-AB170

Author(s):

Yang Du ◽

Kelong Fan ◽

Hejun Zhang ◽

Shigang Ding ◽

Xiyun Yan ◽

...

Keyword(s):

Gastric Cancer ◽

Molecular Imaging ◽

Early Gastric Cancer ◽

Heavy Chain ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser

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PS02.062: CONFOCAL LASER ENDOMICROSCOPY IN THE ASSESSMENT OF PERSISTENT/RECURRENT INTESTINAL METAPLASIA/NEOPLASIA AFTER ENDOSCOPIC TREATMENT OF BORN

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.062 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 138-138

Author(s):

Jana Krajciova ◽

Marek Kollar ◽

Jana Maluskova ◽

Martin Kment ◽

Zuzana Vackova ◽

...

Keyword(s):

Intestinal Metaplasia ◽

Predictive Value ◽

Endoscopic Treatment ◽

Conflicts Of Interest ◽

Intraepithelial Neoplasia ◽

Detailed Examination ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Histopathological Analysis ◽

Low Grade

Abstract Background Patients after endoscopic treatment of Barrett's esophagus related neoplasia (BORN) should undergo regular endoscopic surveillance with biopsies to detect recurrent intestinal metaplasia (IM) or neoplasia (N). Probe-based confocal laser endomicroscopy (pCLE) offers detailed examination of cellular structures and may examine larger areas compared to standard biopsy. Methods A single center, prospective, controlled and pathologist-blinded (still ongoing) study in patients undergoing surveillance endoscopy after endoscopic treatment of BORN. pCLE images were obtained from the neo-Z-line (in few cases including macroscopically visible tongues), the cardia and the esophagus. Thereafter, standard biopsies were taken and sent for histopathological analysis (minimally 4 biopsies from macroscopically normal neo-Z-line, 2 biopsies from the cardia and the esophagus and targeted biopsies from visible abnormalities, if present). Results We examined 34 patients, from these 14 patients (41%) had the initial diagnosis of low-grade intraepithelial neoplasia (LGIN), 8 patients (24%) had high-grade intraepithelial neoplasia (HGIN) and 12 patients (35%) had an early adenocarcinoma (EAC). Three patients (9%) underwent endoscopic resection (ER), in 18 patients (53%) we performed ER or dissection of all visible lesions followed by radiofrequency ablation (RFA), and 13 patients (38%) had RFA as a single treatment modality. Persistent/recurrent IM was detected only at the level of neo-Z-line in 8 patients (24%, 8/34 pts) by both methods. pCLE but not biopsies detected persistent/recurrent IM in 2 patients (6%, 2/34), another 2 patients had IM present in biopsies but not in pCLE. pCLE diagnosed one patient with recurrent LGIN in a macroscopic visible tongue arising from neo-Z-line, which was not confirmed in biopsies (there was only agreement in persistent IM detected by both methods). Sensitivity and specificity of pCLE in detection of persistent/recurrent IM was 80% (95% CI 44–98) and 92% (95% CI 73–99), respectively, with a positive predictive value of 80% (95% CI 51–94) and a negative predictive value of 92% (95% CI 76–98). Agreement of pCLE and histopathological findings was 88%. Conclusion pCLE seems comparable to standard biopsies in detection of persistent/recurrent IM after endoscopic treatment of BORN. Nevertheless, these results need to be confirmed in a larger cohort of patients. Disclosure All authors have declared no conflicts of interest.

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