Identifying intestinal metaplasia at the squamocolumnar junction by using optical coherence tomography
Identifying intestinal metaplasia at the squamocolumnar junction by using optical coherence tomography
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DOI：
10.1016/j.gie.2006.04.027
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发表时间：
2007-01-01
影响因子：
7.7
通讯作者：
Tearney, Guillermo J.
中科院分区：
文献类型：
--
作者：
Evans, John A.;Bouma, Brett E.;Tearney, Guillermo J.
背景：光学相干断层扫描（OCT）是一种光学成像方法，可产生食道的高分辨率横截面图像。 OCT 区分鳞柱交界处 (SCJ) 组织类型的准确性尚未确定。目的：本研究的目的是确定和验证区分 SCJ 化生组织和非化生组织的 OCT 图像标准。设计：从 113 名接受上消化道内窥镜检查的患者中采集了总共 196 个与 SCJ 活检相关的 OCT 图像。一位对 OCT 结果不知情的病理学家对每张图像进行了审查 病理标本并确定以下组织病理学的存在：贲门、鳞状粘膜、胰化生和肠化生。通过审查 40 张活检相关 OCT 图像的训练集，创建了一种用于诊断特殊肠上皮化生 (SIM) 的算法。两名盲法研究人员在 123 张图像的验证集上前瞻性地测试了该算法。结果：鳞状粘膜的 OCT 图像的特点是分层外观，没有上皮腺体；胃贲门，具有垂直的小凹和腺体结构，上皮表面反射率清晰，图像穿透力相对较差； SIM具有不规则的架构和良好的图像穿透力。当回顾性应用于训练集时，OCT 标准对 SIM 的敏感性为 85%，特异性为 95%。当应用于验证集时，该算法对于 OCT 读取器的敏感性为 81%，对于诊断 SIM 的特异性为 66% 和 57%。观察者间一致性良好（kappa = 0.53）。结论：OCT 成像可以识别 SCJ 处的 SIM，其准确度与内窥镜检查相似。
Background: Optical coherence tomography (OCT) is an optical imaging method that produces high-resolution cross-sectional images of the esophagus. The accuracy of OCT for differentiating tissue types at the squamocolumnar junction (SCJ) has not been established.Objective: The purpose of this study was to identify and validate OCT image criteria for distinguishing metaplastic from nonmetaplastic tissue at the SCJ.Design: A total of 196 biopsy-correlated OCT images of the SCJ were acquired from 113 patients undergoing upper endoscopy A pathologist blinded to the OCT results reviewed each pathology specimen and determined the presence of the following histopathology: gastric cardia, squamous mucosa, pancreatic metaplasia, and intestinal metaplasia. An algorithm for diagnosing specialized intestinal metaplasia (SIM) was created by reviewing a training set of 40 biopsy-correlated OCT images. Two blinded investigators prospectively tested the algorithm on a validation set of 123 images.Results: OCT images of squamous mucosa were characterized by a layered appearance without epithelial glands; gastric cardia, by vertical pit and gland structure, a well-defined epithelial Surface reflectivity, and relatively poor image penetration; and SIM by an irregular architecture and good image penetration. The OCT criteria were 85% sensitive and 95% specific for SIM when applied retrospectively to the training set. When applied to the validation set, the algorithm was 81% sensitive for both OCT readers and 66% and 57% specific for diagnosing SIM. The interobserver agreement was good (kappa = 0.53).Conclusions: OCT imaging can identify SIM at the SCJ with an accuracy similar to that of endoscopy.