SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2017/06  
 
  2017 Jun;85(6):1195-1207  
  doi: 10.1016/j.gie.2016.09.031.  
 
  Diagnostic accuracy of probe-based confocal laser endomicroscopy in Lugol-unstained esophageal superficial lesions of patients with head and neck cancer  
 
  Safatle-Ribeiro AV, Baba ER, Faraj SF, Rios JT, de Lima MS, Martins BC, Geiger SN, Pennacchi C, Gusman C, Kawaguti FS, Uemura RS, de Melo ES, Ribeiro U Jr, Maluf-Filho F  
  https://www.ncbi.nlm.nih.gov/pubmed/27697445  
 
 

Abstract

BACKGROUND AND AIMS:

Surveillance programs of patients with head and neck cancer (HNC) detect synchronous or metachronous esophageal squamous cell carcinoma (ESCC) in up to 15% of patients. Noninvasive, probe-based confocal laser endomicroscopy (pCLE) technique may improve the diagnosis allowing acquisition of high-resolution in vivo images at the cellular and microvascular levels. The aim of this study was to evaluate the accuracy of pCLE for the differential diagnosis of nonneoplastic and neoplastic Lugol-unstained esophageal lesions in patients with HNC.

METHODS:

Twenty-seven patients with HNC who exhibited Lugol-unstained esophageal lesions at surveillance endoscopy were prospectively included for pCLE. Diagnostic pCLE was followed by subsequent biopsies or endoscopic resection of suspected lesions. A senior pathologist was blinded to the pCLE results.

RESULTS:

Patients mean age was 59 years (SD = 8.8) and 70.4% were men. All patients were smokers, and 22 patients (81.5%) had a history of alcohol consumption. The locations of HNC were oral cavity (n = 13), larynx (n = 10), and pharynx (n = 4). Thirty-seven lesions in 27 patients were studied. The final diagnoses were ESCC in 17 patients and benign lesions in 20 patients. Sensitivity, specificity, and accuracy of pCLE for the histologic diagnosis of ESCC in patients with HNC were 94.1%, 90.0%, and 91.9%, respectively.

CONCLUSIONS:

First, pCLE is highly accurate for real-time histology of Lugol-unstained esophageal lesions in patients with HNC. Second, pCLE may alter the management of patients under surveillance for ESCC, guiding biopsies and endoscopic resection, avoiding further diagnostic workup or therapy of benign lesions.

 

 
Question posée
 
L’endomicroscopie confocale par minisonde (ECM) est-elle efficace pour caractériser les lésions lugol-négatives ?
 
Question posée
 
Sensibilité de 94% et spécificité de 90%.
 
Commentaires

Avec de telles performances diagnostiques, l’ECM pourrait devenir un outil intéressant pour caractériser et décider en temps réel de traiter les lésions oesophagiennes et oro-pharyngées lugol-négatives des patients surveillés pour cancer ORL. Il s’agit cependant d’un petit effectif, et une étude randomisée comparant l’ECM à l’endoscopie haute résolution avec zoom et chromoscopie digitale serait souhaitable.

 
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