Quantitative diagnostic algorithm using endocytoscopy for superficial nonampullary duodenal epithelial tumors

Area of Science:

• Gastroenterology
• Endoscopy
• Oncology

Background:

• Optical biopsy using endocytoscopy for superficial nonampullary duodenal epithelial tumors (SNADETs) is practical.
• A diagnostic algorithm for endocytoscopy in SNADETs has not been established.

Purpose of the Study:

• To determine correlations between endocytoscopic findings and histology of SNADETs using computer analysis.
• To establish a diagnostic algorithm for endoscopic intervention of SNADETs.

Main Methods:

• Retrospective analysis of endocytoscopic and histological images from 70 patients.
• Computer analysis of gland numbers and densely stained areas with methylene blue (DSMs) per mm² and per screen.
• Correlation analysis between endocytoscopy and histology, with diagnoses based on the revised Vienna classification.

Main Results:

• A significant correlation was found between the number of glands in endocytoscopy and histology (ρ = 0.64, P < 0.001).
• Significant differences in mean gland number and DSM percentage were observed between different Vienna classification categories.
• An algorithm with cutoffs for gland number (47/mm²) and DSM percentage (20.8%) achieved an area under the ROC curve of 0.89.

Conclusions:

• Endocytoscopic images of SNADETs reflect histopathological atypia.
• Computer analysis of endocytoscopic findings provides a practical diagnostic algorithm for guiding endoscopic intervention.