Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy in gastrointestinal subepithelial lesions: Feasibility study

Tsuyoshi Terada, Tomomitsu Tahara, Senju Hashimoto, Noriyuki Horiguchi, Kohei Funasaka, Mitsuo Nagasaka, Yoshihito Nakagawa, Tomoyuki Shibata, Kentaro Yoshioka, Tetsuya Tsukamoto, Makoto Kuroda, Naoki Ohmiya

Research output: Contribution to journalArticle

Abstract

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).

Original languageEnglish
JournalDigestive Endoscopy
DOIs
Publication statusAccepted/In press - 01-01-2019

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Feasibility Studies
Needles
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Lasers
Leiomyoma
Neoplasms
Pathology
Neoplasm Metastasis
Biopsy

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Terada, Tsuyoshi ; Tahara, Tomomitsu ; Hashimoto, Senju ; Horiguchi, Noriyuki ; Funasaka, Kohei ; Nagasaka, Mitsuo ; Nakagawa, Yoshihito ; Shibata, Tomoyuki ; Yoshioka, Kentaro ; Tsukamoto, Tetsuya ; Kuroda, Makoto ; Ohmiya, Naoki. / Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy in gastrointestinal subepithelial lesions : Feasibility study. In: Digestive Endoscopy. 2019.
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abstract = "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).",
author = "Tsuyoshi Terada and Tomomitsu Tahara and Senju Hashimoto and Noriyuki Horiguchi and Kohei Funasaka and Mitsuo Nagasaka and Yoshihito Nakagawa and Tomoyuki Shibata and Kentaro Yoshioka and Tetsuya Tsukamoto and Makoto Kuroda and Naoki Ohmiya",
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Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy in gastrointestinal subepithelial lesions : Feasibility study. / Terada, Tsuyoshi; Tahara, Tomomitsu; Hashimoto, Senju; Horiguchi, Noriyuki; Funasaka, Kohei; Nagasaka, Mitsuo; Nakagawa, Yoshihito; Shibata, Tomoyuki; Yoshioka, Kentaro; Tsukamoto, Tetsuya; Kuroda, Makoto; Ohmiya, Naoki.

In: Digestive Endoscopy, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy in gastrointestinal subepithelial lesions

T2 - Feasibility study

AU - Terada, Tsuyoshi

AU - Tahara, Tomomitsu

AU - Hashimoto, Senju

AU - Horiguchi, Noriyuki

AU - Funasaka, Kohei

AU - Nagasaka, Mitsuo

AU - Nakagawa, Yoshihito

AU - Shibata, Tomoyuki

AU - Yoshioka, Kentaro

AU - Tsukamoto, Tetsuya

AU - Kuroda, Makoto

AU - Ohmiya, Naoki

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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).

AB - 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).

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