In vivo diagnosis of early-stage gastric cancer found after Helicobacter pylori eradication using probe-based confocal laser endomicroscopy

Abstract

Background and Aim

Early-stage gastric cancer (EGC) found after Helicobacter pylori (Hp) eradication often displays non-tumorous regenerative epithelium and/or maturated tumorous epithelium overlying the cancerous tissue, which may confuse endoscopic and histologic diagnosis. Probe-based confocal laser endomicroscopy (pCLE) enables in vivo real-time optical biopsy. We compared the diagnostic yields for these EGC cases using conventional white light endoscopy (WL), magnifying endoscopy with narrow-band imaging (ME-NBI), pCLE, and endoscopic biopsy; we also compared the accuracy of the horizontal extent diagnosis between ME-NBI and pCLE.

Methods

This study enrolled 30 patients with 36 EGC lesions after successful Hp eradication. The diagnostic yields of WL, ME-NBI, pCLE, and endoscopic biopsy were prospectively compared. Four points of cancerous margins (oral, anal, anterior, and posterior sites) were also prospectively evaluated with M-NBI and pCLE to determine the horizontal extent of the EGC.

Results

The diagnostic yield was significantly higher with pCLE than with WL and endoscopic biopsy (97 vs. 72%, 97 vs. 72%, P=0.0159, 0.0077, respectively), whereas it did not differ from ME-NBI (88.9%, P=0.371). The height of non-tumorous regenerative epithelium or maturated atypical glands was 104.7±34.2 μm in the pCLE-positive cases, whereas it was 188.3±27.1 μm in a pCLE-negative case (P=0.0004). The diagnostic accuracy of the horizontal margin of EGC was significantly higher with pCLE than with ME-NBI (92 vs. 70%, P=0.0159).

Conclusion

pCLE may be helpful for the diagnosis of ambiguous ECGs found after Hp eradication because it enables real-time scanning throughout the lesion and the detection of subsurface microstructure.

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