Value of probe-based confocal laser endomicroscopy for differential diagnosis of biliary stricture / 中华消化内镜杂志

ABSTRACT

Objective To discuss the feasibility and application value of probe-based confocal laser endomicroscopy(pCLE)for differential diagnosis of maligant biliary stricture. Methods The pCLE images of 10 patients with definite biliary structure were retrospectively analyzed to establish pCLE classification of biliary lesions, and then the patients, who accepted pCLE examination and traditional brush cytology successively,were selected for further prospective research. Each patient was scored in terms of sign of malignant lesion to analyze diagnostic efficacy of combinations of different signs using classification standard of pCLE image. The results were compared with cell brushing test. The diagnostic consistency of observers using pCLE was also evaluated. Results A total of 25 patients completed the prospective research. When patients presented with any two or more malignant signs,diagnostic efficacy of pCLE was best with accuracy rate of 84.0%(95%CI64.7%-94.2%),and sensitivity,specificity,positive predictive value and negative predictive value was 87.5%(95% CI 62.7%-97.8%), 77.8%(95% CI 44.3%-94.7%), 87.5% (95%CI 62.7%-97.8%), and 77.8%(95% CI 44.3%-94.7%), respectively. The corresponding indicators of brush cytology was 56.0%(95% CI 37.1%-73.4%), 31.3%(95% CI 13.9%-55.9%), 100.0%(95%CI65.5%-100.0%),100.0%(95%CI51.1%-100.0%),and 45.0%(95%CI25.8%-65.8%),respectively,and the sensitivity(P=0.001)and accuracy(P=0.03)were significantly lower than that of pCLE. The κ value of interobserver agreement level was 0.73, which revealed a significant consistency. Conclusion pCLE provides a new approach for the differential diagnosis of biliary stricture, and shows a potential clinical application value.