Early detection of lung cancer with laser-induced fluorescence endoscopy and spectrofluorometry
Early detection of lung cancer with laser-induced fluorescence endoscopy and spectrofluorometry
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DOI：
10.1378/chest.118.6.1776
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发表时间：
2000-12-01
期刊：
影响因子：
9.6
通讯作者：
Horai, T
中科院分区：
文献类型：
--
作者：
Kusunoki, Y;Imamura, F;Horai, T
研究目标：我们进行了一项激光诱导荧光内窥镜 (LIFE) 临床试验，用于检测白光支气管镜难以检测到的癌前病变和癌症，包括原位癌 (CIS)。设计：将 LIFE 的结果与标准白光支气管镜进行比较。对这些内窥镜结果进行荧光光谱评估，并对由红色和绿色强度的数字信号组成的 LIFE 图像的像素进行分析。设置：三级医院治疗转诊和大规模筛查结果可疑的受试者。患者：我们用两种方法检查了 65 名疑似肺癌受试者，并对 216 个病灶进行了活检。结果：以组织病理学结果为标准，白光支气管镜诊断的准确性为48.6%。 LIFE 的准确率为 72.7%。传统支气管镜检查检测严重不典型增生（21 个活检标本）或癌症（28 个活检标本）的敏感性为 61.2%，特异性为 85.0%。加上 LIFE 的结果，这些值分别为 89.8% 和 78.4%。在 9 名 CIS 患者中，只有 LIFE 显示 1 个病变，并且只有 LIFE 显示 7 个病变的范围。通过荧光分光光度法测量八个病变的自发荧光；正常支气管组织、严重不典型增生和癌组织具有光谱差异。 LIFE图像直方图上癌症的红/绿强度通常大于化生或正常支气管壁的比率。结论：使用这两种方法应该有助于早期发现。通过荧光分光光度法评价，并通过LIFE对结果进行数字信号强度分析，使结果更加客观。
Study objectives: We performed a clinical trial of laser-induced fluorescence endoscopy (LIFE) for detection of precancerous lesions and cancer including carcinoma in situ (CIS), which are difficult to detect by white-light bronchoscopy.Design: Results with LIFE were compared with the criterion standard, white-light bronchoscopy. The evaluation of these endoscopic results spectrofluorometrically was examined, and pixels of LIFE images composed of digital signals for the intensities of red and green were analyzed.Setting: Tertiary-level hospital treating referrals and subjects with suspicious results in mass screening.Patients: We examined 65 subjects with suspected lung cancer by both methods, and performed biopsy on 216 lesions.Results: The accuracy of diagnosis by white-light bronchoscopy, with histopathologic results as the standard, was 48.6%. The accuracy by LIFE was 72.7%. The sensitivity of conventional bronchoscopy for detection of severe dysplasia (21 biopsy specimens) or cancer (28 biopsy specimens) was 61.2% and specificity was 85.0%. With results by LIFE added, these values were 89.8% and 78.4%, respectively. Of nine patients with CIS, only LIFE showed one lesion, and only LIFE showed the extent of seven of the lesions. The autofluorescence of eight lesions was measured spectrofluorometrically; normal bronchial tissue, severe dysplasia, and cancerous tissue had spectral differences. The red/green intensity of cancers on histograms of LIFE images generally was greater than the ratios for metaplasia or normal bronchial wall.Conclusions: Use of both methods should facilitate early detection. Evaluation by spectrofluorometry and analysis of digital signal intensity of results by LIFE make results more objective.