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BACKGROUNDAND STUDY AIMS: Advances in endoscopy have led to imaging of the details of thegastric mucosa, but the histological diagnosis usually has to be confirmed byendoscopic biopsy. A method of confocal endomicroscopy that has recently beendeveloped allows the observation of living cells in vivo. Several investigatorshave reported that the technique is of value, but there have as yet been nostudies describing its application in gastric cancer. PATIENTS AND METHODS:Twenty-seven patients with early gastric cancer underwent confocalendomicroscopy (Pentax EG-3870CIK; Pentax, Tokyo, Japan).After intravenous administration of fluorescein sodium, confocal images obtainedfrom the normal mucosa and from cancerous lesions were interpreted by twopathologists independently and compared with the histological findings,including CD34 immunostaining of biopsy specimens or resected specimens fromthe same sites. RESULTS: Fluorescein yielded high-quality confocal images ofthe gastric mucosa; if cancer could be targeted (59 %) images were mostlygraded good. The images corresponded to the hematoxylin-eosin staining oftransverse sections of specimens from the same sites. In the results for theinterpretation by the two pathologists, the accuracy for the diagnosis ofgastric cancer was 94.2 % (pathologist A), and 96.2 % (pathologist B),respectively. The accuracy decreased substantially when poor images andinaccessible lesions were included. CONCLUSIONS: Confocal endomicroscopy isuseful in the diagnosis of gastric cancer but good quality images cannot alwaysbe obtained. In the future, it may allow virtual biopsy and help reduceunnecessary biopsies.Leggil'articolo