Confocal laser endomicroscopy for superficial esophageal squamous cell carcinoma

Background and study aims: Confocal laser endomicroscopy (CLE) allows subsurface imaging of gastrointestinal mucosa in vivo. The goal of the present study was to compare the endomicroscopic characteristics of cells and intrapapillary capillary loops (IPCLs) in normal and superficial esophageal squamous cell carcinoma (SESC). Patients and methods: We recruited consecutive patients with SESC diagnosed by conventional endoscopy and confirmed by histopathology between July 2006 and May 2008. The confocal endoscopic images of these patients were collected and compared with the corresponding histology. The characteristic patterns of cells and IPCLs was then analyzed from these images of malignant and normal mucosa. The quality of images and interobserver variations of two endoscopists were also evaluated. Results: Overall, 64 samples from 57 subjects (27 SESCs, 30 controls) were examined by CLE. The confocal images corresponded to the hematoxylin and eosin staining from the same sites. The confocal images showed that there was a significantly higher proportion of squamous epithelial cells with irregular arrangement (79.4% vs. 10.0%, P < 0.001), increased diameter of IPCLs (26.0 mu m vs. 19.2 mu m, P < 0.001), and irregular shape IPCLs (82.4% vs. 36.7%, P = 0.0002) in the SESC group compared with the controls. Massive IPCLs with tortuous vessels (44.1% vs. 0%, P < 0.0001), and long branching IPCLs (23.5% vs. 3.3%, P = 0.0204) were frequently observed in the SESC group. In this study, about 35.5% of images were graded as good quality, and the interobserver agreement for the prediction of cancerous mucosa was graded as substantial. Conclusions: CLE can be used to distinguish cancerous from normal epithelium, which gives it potential value for early detection of esophageal carcinoma. The difficulty in obtaining good images in the esophagus by CLE is a latent problem.