Comparison of diagnostic accuracy of endocytoscopy and probe-based confocal laser endomicroscopy

Aims Traditionally, biopsies have been regarded as the most accurate method for diagnosing gastrointestinal systems. However, the risks of sampling errors and post-biopsy inflammatory changes can make endoscopic procedures challenging. Therefore, in vivo methods have gained importance, with endocytoscopy and probe-based confocal laser endomicroscopy (pCLE) emerging as prominent techniques. Despite their significance, there has been no study comparing these two methods to date. This retrospective study aims to compare the accuracy and clinical utility of these two diagnostic approaches.

Methods In this study, a total of 110 patients with various gastrointestinal lesions were examined using pCLE and dye-based endocytoscopy. The primary objective was to compare the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of these diagnostic methods. The secondary outcomes included comparing the rate of obtaining diagnostically viable images with each method and evaluating the organ-specific diagnostic rates when both methods were used in conjunction.

Results The study found that pCLE had a sensitivity of 100% (95% CI: 94.42% to 100%), specificity of 78.57% (95% CI: 52.41% to 92.43%), positive predictive value (PPV) of 95.59% (95% CI: 87.81% to 98.49%), negative predictive value (NPV) of 100% (95% CI: 74.12% to 100%), and an overall accuracy of 96.20% (95% CI: 89.42% to 98.70%). In comparison, endocytoscopy showed a sensitivity of 47.69% (95% CI: 36.02% to 59.62%), specificity of 85.71% (95% CI: 60.06% to 95.99%), PPV of 93.94% (95% CI: 80.39% to 98.32%), NPV of 26.09% (95% CI: 15.60% to 40.26%), and accuracy of 54.43% (95% CI: 43.50% to 64.95%). The differences in sensitivity, NPV, and accuracy between the two groups were statistically significant (P value<0.001), but no significant differences were observed in specificity and PPV (P=0.720). [1] [2] [3] [4] [5] [6]

Conclusions pCLE demonstrated statistically superior performance over endocytoscopy in terms of sensitivity, NPV, and overall accuracy. However, there were no significant differences in positive predictive value PPV and specificity between the two methods. It was also noted that obtaining diagnostic-quality images was more challenging with endocytoscopy. Remarkably, when both methods were employed together, the diagnostic accuracy approached nearly 100%.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

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Publication History

Article published online:
15 April 2024