Subscribe to RSS
DOI: 10.1055/s-0034-1392235
Diagnostic values of dual focus narrow band imaging and probe-based confocal laser endomicroscopy in FAP-related duodenal adenoma
Publication History
submitted 19 January 2015
accepted after revision 16 April 2015
Publication Date:
23 June 2015 (online)
Background and study aims: Familial adenomatous polyposis (FAP) is associated with an increased risk of development of periampullary and nonampullary adenoma. Either routine biopsy or endoscopic removal of the lesion is generally required to identify the presence of adenoma. Because the risk of tissue sampling from the ampulla is high and nonampullary polyps are sometimes numerous, resection of all the lesions is time-consuming. This study aimed to evaluate the diagnostic values of duodenal adenoma by dual focus NBI (dNBI) and probe-based confocal endomicroscopy (pCLE) in FAP patients.
Patients and methods: The authors conducted a diagnostic study in a single tertiary-care referral center. Surveillance esophagogastroduodenoscopy with dNBI and pCLE was performed on 26 patients with FAP for real-time adenoma diagnosis by two different endoscopists; one used dNBI and the other pCLE. Histology from the matched lesion was used as the gold standard.
Results: A total of 55 matched biopsies (25 ampullas, 30 nonampullas) were performed. The sensitivity, specificity, post predictive value (PPV), negative predictive value (NPV), and accuracy of dNBI vs. pCLE from all duodenal lesions were 96.9 % vs. 93.8 %, 78.3 % vs. 81 %, 86.1 % vs. 88.2 %, 94.7 vs. 89.5 %, and 92.4 % vs. 88.6 %, respectively.
Conclusions: For surveillance of periampullary and nonampullary adenoma in patients with FAP, the real-time readings provided a high degree of diagnostic value when histology was used as the gold standard. (Clinical trial registration number: NCT02162173).
-
References
- 1 Groden J, Thliveris A, Samowitz W et al. Identification and characterization of the familial adenomatous polyposis coli gene. Cell 1991; 66: 589-600
- 2 Rustgi AK. Hereditary gastrointestinal polyposis and nonpolyposis syndromes. N Engl J Med 1994; 331: 1694-1702
- 3 Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N Engl J Med 2003; 348: 919-932
- 4 Kadmon M, Tandara A, Herfarth C. Duodenal adenomatosis in familial adenomatous polyposis coli. A review of the literature and results from the Heidelberg Polyposis Register. Int J Colorectal Dis 2001; 16: 63-75
- 5 Spigelman AD, Williams CB, Talbot IC et al. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 1989; 2: 783-785
- 6 Jagelman DG, DeCosse JJ, Bussey HJ. Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet 1988; 1: 1149-1151
- 7 Burke CA, Beck GJ, Church JM et al. The natural history of untreated duodenal and ampullary adenomas in patients with familial adenomatous polyposis followed in an endoscopic surveillance program. Gastrointest Endosc 1999; 49: 358-364
- 8 Dekker E, Fockens P. Advances in colonic imaging: new endoscopic imaging methods. Eur J Gastroenterol Hepatol 2005; 17: 803-808
- 9 Kuiper T, van den Broek FJ, van Eeden S et al. Feasibility and accuracy of confocal endomicroscopy in comparison with narrow band imaging and chromoendoscopy for the differentiation of colorectal lesions. Am J Gastroenterol 2012; 107: 543-550
- 10 Shahid MW, Buchner AM, Heckman MG et al. Diagnostic accuracy of probe-based confocal laser endomicroscopy and narrow band imaging for small colorectal polyps: a feasibility study. Am J Gastroenterol 2012; 107: 231-239
- 11 Uchiyama Y, Imazu H, Kakutani H et al. New approach to diagnosing ampullary tumors by magnifying endoscopy combined with a narrow band imaging system. J Gastroenterol 2006; 41: 483-490
- 12 Lopez-Ceron M, van den Broek FJ, Mathus-Vliegen EM et al. The role of high-resolution endoscopy and narrow band imaging in the evaluation of upper GI neoplasia in familial adenomatous polyposis. Gastrointest Endosc 2013; 77: 542-550
- 13 Pittayanon R, Rerknimitr R, Wisedopas N et al. Flexible spectral imaging color enhancement plus probe-based confocal laser endomicroscopy for gastric intestinal metaplasia detection. J Gastroenterol Hepatol 2013; 28: 1004-1009
- 14 Pittayanon R, Rerknimitr R, Wisedopas N et al. The learning curve of gastric intestinal metaplasia interpretation on the images obtained by probe-based confocal laser endomicroscopy. Diagn Ther Endosc 2012; 2012: 278045
- 15 Rerknimitr R, Imraporn B, Klaikeaw N et al. Non-sequential narrow band imaging for targeted biopsy and monitoring of gastric intestinal metaplasia. World J Gastroenterol 2011; 17: 1336-1342
- 16 Schlemper RJ, Riddell RH, Kato Y et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
- 17 Picasso M, Filiberti R, Blanchi S et al. The role of chromoendoscopy in the surveillance of the duodenum of patients with familial adenomatous polyposis. Dig Dis Sci 2007; 52: 1906-1909
- 18 Norton ID, Gostout CJ. Management of periampullary adenoma. Digestive diseases 1998; 16: 266-273
- 19 Ryan DP, Schapiro RH, Warshaw AL. Villous tumors of the duodenum. Ann Surg 1986; 203: 301-306
- 20 Clary BM, Tyler DS, Dematos P et al. Local ampullary resection with careful intraoperative frozen section evaluation for presumed benign ampullary neoplasms. Surgery 2000; 127: 628-633
- 21 Blackman E, Nash SV. Diagnosis of duodenal and ampullary epithelial neoplasms by endoscopic biopsy: a clinicopathologic and immunohistochemical study. Hum Pathol 1985; 16: 901-910
- 22 Menzel J, Poremba C, Dietl KH et al. Tumors of the papilla of Vater--inadequate diagnostic impact of endoscopic forceps biopsies taken prior to and following sphincterotomy. Ann Oncol 1999; 10: 1227-1231
- 23 Kiesslich R, Mergener K, Naumann C et al. Value of chromoendoscopy and magnification endoscopy in the evaluation of duodenal abnormalities: a prospective, randomized comparison. Endoscopy 2003; 35: 559-563
- 24 Dekker E, Boparai KS, Poley JW et al. High resolution endoscopy and the additional value of chromoendoscopy in the evaluation of duodenal adenomatosis in patients with familial adenomatous polyposis. Endoscopy 2009; 41: 666-669
- 25 Shahid MW, Buchner A, Gomez V et al. Diagnostic accuracy of probe-based confocal laser endomicroscopy and narrow band imaging in detection of dysplasia in duodenal polyps. J Clin Gastroenterol 2012; 46: 382-389
- 26 Hasama K. [An electron microscopic study on human intestinal epithelial cells during lipid absorption obtained by endoscopic biopsy under direct vision]. Nihon Shokakibyo Gakkai Zasshi 1982; 79: 1405-1411
- 27 Bulow S, Bjork J, Christensen IJ et al. Duodenal adenomatosis in familial adenomatous polyposis. Gut 2004; 53: 381-386
- 28 Groves CJ, Saunders BP, Spigelman AD et al. Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study. Gut 2002; 50: 636-641
- 29 Rex DK, Kahi C, O'Brien M et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2011; 73: 419-422
- 30 Maehata Y, Esaki M, Hirahashi M et al. Duodenal adenomatosis in Japanese patients with familial adenomatous polyposis. Dig Endosc 2014; 26: 30-34