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Detection of cholangiocarcinoma in vivo using miniprobe-based confocal fluorescence microscopy
Alexander Meining1, Eckart Frimberger, Valentin Becker
1Department of Medicine II, Technical University of Munich, Munich, Germany. alexander.meining@lrz.tu-m.de
Background & Aims:
The preoperative diagnosis of cholangiocarcinoma is associated with a low sensitivity. To overcome this limitation, a new imaging modality was evaluated to detect neoplasia in vivo in the biliary tract.
Methods:
Fourteen patients with biliary strictures were examined. Mucosal imaging was performed with a miniaturized confocal laser scanning miniprobe introduced via the accessory channel of a cholangioscope. Thereafter, targeted biopsy specimens were taken from the same regions.
Results:
All strictures could be reached. Presence of irregular vessels use confocal laser microscopy enabled prediction of neoplasia with an accuracy rate of 86%, sensitivity of 83%, and specificity of 88%. The respective numbers for standard histopathology were 79%, 50%, and 100%. The mean signal-to-noise-ratio of laser microscopic images acquired from malignant strictures differed significantly from those of benign origin (1.8 +/- 0.8 vs 2.6 +/- 1.0; P = .005).
Conclusions:
Miniprobe-based confocal laser scanning microscopy considerably increases sensitivity for the detection of biliary neoplasia and therefore represents a promising diagnostic approach.
