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Technology Insight: confocal laser endoscopy for in vivo diagnosis of colorectal cancer

Nature Clinical Practice Oncology volume 4, pages 480–490 (2007)Cite this article

Abstract

Recent studies on a novel technology, denoted confocal laser endomicroscopy (CLE), have altered thinking about the possibilities of endoscopy in the diagnosis and treatment of colorectal cancer. CLE is a new endoscopic tool that allows in vivo histology at subcellular resolution during ongoing endoscopy, and permits subsurface imaging of normal and neoplastic human mucosa. This new technique has unequivocal major implications for the diagnosis and clinical management of patients scheduled for screening or surveillance colonoscopy for colorectal cancer. For instance, CLE allows immediate diagnosis of colonic neoplasias, and the detection of neoplastic cells helps to target endoscopic intervention to relevant areas. Furthermore, the combination of chromoendoscopy with CLE significantly decreases the number of biopsies required for cancer surveillance in patients with ulcerative colitis, but provides a fourfold higher diagnostic yield compared with white-light endoscopy used with random biopsies. Taken together, CLE has led colorectal cancer endoscopy into a new era. CLE can no longer be regarded as just another endoscopic technique, but emerges as a crucial novel imaging technique for in vivo diagnosis of colorectal cancer.

Key Points

  • Confocal laser endomicroscopy is a new diagnostic tool allowing in vivo microscopy at subcellular resolution during ongoing endoscopy

  • Endomicroscopy can be used to immediately diagnose colorectal cancer or intraepithelial neoplasia

  • Endomicroscopy allows biopsies to be targeted to microscopic suspicious areas, leading to a substantial reduction in the number of conventional biopsies

  • The combination of chromoendoscopy and endomicroscopy improves the diagnostic yield of intraepithelial neoplasias in patients with long-standing ulcerative colitis

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Figure 1: Technique of confocal laser endomicroscopy
Figure 2: Chromoendoscopy: in vivo imaging and histology of normal colonic mucosal crypt architecture
Figure 3: White-light endoscopy, in vivo imaging and histology of normal villi architecture of the terminal ileum
Figure 4: Tubular adenoma with low grade intraepithelial neoplasia
Figure 5: Hyperplasia and aberrant crypt foci
Figure 6: Ulcerative colitis associated neoplasias
Figure 7: Endomicroscopy of a patient with colorectal cancer
Figure 8: Endomicroscopy and histology of a colorectal cancer

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Authors and Affiliations

  1. R Kiesslich is Head of the Endoscopy Unit, M Goetz is a Consultant Gastroenterologist, PR Galle is Chairman, and MF Neurath is Professor of Medicine and Head of the Endoscopy Unit, all at the I Medical Clinic, Johannes Gutenberg University, Mainz, and M Vieth is a Consultant at the Institute of Pathology, Clinic of Bayreuth, Bayreuth, Germany.,

    Ralf Kiesslich, Martin Goetz, Michael Vieth, Peter R Galle & Markus F Neurath

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  1. Ralf Kiesslich
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  2. Martin Goetz
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Correspondence to Ralf Kiesslich.

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Competing interests

Ralf Kiesslich and Markus F Neurath have received an unrestricted grant from Pentax Europe and M Vieth has been on a speaker's bureau for Pentax Europe. The other authors declared no competing interests.

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Kiesslich, R., Goetz, M., Vieth, M. et al. Technology Insight: confocal laser endoscopy for in vivo diagnosis of colorectal cancer. Nat Rev Clin Oncol 4, 480–490 (2007). https://doi.org/10.1038/ncponc0881

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