Endoscopic video-autofluorescence imaging followed by narrow band imaging for detecting early neoplasia in Barrett's esophagus
Endoscopic video-autofluorescence imaging followed by narrow band imaging for detecting early neoplasia in Barrett's esophagus
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DOI：
10.1016/j.gie.2005.11.050
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发表时间：
2006-08-01
影响因子：
7.7
通讯作者：
Bergman, Jacques J. G. H. M.
中科院分区：
文献类型：
--
作者：
Kara, Mohammed A.;Peters, Femke P.;Bergman, Jacques J. G. H. M.
背景资料：视频自体荧光成像（AFI）和窄带成像（NBI）是新的内窥镜技术，可以提高巴雷特食管（BE）中高级别上皮内瘤变（HGIN）的检测。AFI可提高病变检出率，但可能出现假阳性结果。NBI允许详细检查粘膜和（微）血管模式，这与HGIN有关。目的：一项原理验证研究，结合联合收割机AFI和NBI，以提高HGIN的检测，并减少假阳性结果。设计：连续合格患者的横断面研究。设置：单中心。患者：使用2种原型成像系统对20例疑似或经内镜治疗的HGIN BE患者进行了研究：AFI（使用高分辨率视频内窥镜和自体荧光成像进行检查，以检测病变）和NBI（用于详细检查已识别病变的粘膜和血管模式）。结果：AFI和AFI-NBI检测HGIN的阳性预测值，以及NBI检测HGIN的假阳性率的降低。17个被识别为白色光（61%）。AFI检出47个可疑病灶，其中28个含有HGIN（60%），19个为假阳性（40%）。在NBI中，25例真阳性病灶具有明确的可疑模式，3例具有严重的可疑模式。在19个假阳性中，14个在NBI上没有可疑。因此，假阳性率从40%降低到10%。其余5例假阳性中4例为低度异型增生。所有的14例HGIN患者被确定AFI-NBI（灵敏度100%）。局限性：非对照研究在高危patients.Conclusions：这证明的原则研究证实，AFI可以作为一个红旗技术来检测可疑病变。使用NBI，可以对表面图案进行详细检查。这种组合可以提高检测BE中HGIN的准确性。
Background: Video-autofluorescence imaging (AFI) and narrow band imaging (NBI) are new endoscopic techniques that may improve the detection of high-grade intraepithelial neoplasia (HGIN) in Barrett's esophagus (BE). AFI improves the detection of lesions but may give false-positive findings. NBI allows for detailed inspection of the mucosal and (micro)vascular patterns, which are related to HGIN.Objective: A proof-of-principle study to combine AFI and NBI to improve the detection of HGIN and to reduce false-positive findings.Design: Cross-sectional study of consecutive eligible patients.Setting: Single-center.Patients: Twenty patients with BE with suspected or endoscopically treated HGIN were investigated with 2 prototype imaging systems: AFI (inspection with high-resolution videoendoscopy and autofluorescence imaging for detection of lesions) and NBI (for detailed inspection of mucosal and vascular patterns of identified lesions). Lesions were sampled for histopathologic evaluation.Main Outcome Measurements: The positive predictive value of AFI alone and of AFI-NBI for detecting HGIN and the reduction of false-positive findings because of the use of NBI.Results: All of the 28 lesions with HGIN were identified with AFI. Seventeen were identified with white light (61%). Forty-seven suspicious lesions were detected with AFI: 28 contained HGIN (60%) and 19 were false positive (40%). With NBI, 25 of the true-positive lesions had definitely suspicious patterns, and 3 had dubiously suspicious patterns. Of the 19 false positives, 14 were not suspicious on NBI. The false-positive rate, therefore, was reduced from 40% to 10%. Low-grade dysplasia was found in 4 of the remaining 5 false positives. All of the 14 patients with HGIN were identified by AFI-NBI (sensitivity 100%).Limitations: Uncontrolled study in high-risk patients.Conclusions: This proof-of-principle study confirms that AFI can be used as a red-flag technique to detect suspicious lesions. With NBI, detailed inspection of the surface patterns can be performed. This combination may increase the accuracy of detecting HGIN in BE.