Autofluorescence endoscopy in surveillance of Barrett's esophagus:: a multicenter randomized trial on diagnostic efficacy
Autofluorescence endoscopy in surveillance of Barrett's esophagus:: a multicenter randomized trial on diagnostic efficacy
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DOI：
10.1055/s-2006-944726
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发表时间：
2006-09-01
期刊：
影响因子：
9.3
通讯作者：
Meyenberger, C.
中科院分区：
文献类型：
--
作者：
Borovicka, J.;Fischer, J.;Meyenberger, C.
背景和研究目的：Barrett食管患者的参考监测方法是仔细的内窥镜观察，有针对性的以及随机的四象限活检。自体荧光内镜（AFE）可以更容易地定位肿瘤。本研究的目的是阐明与常规方法相比，AFE引导下四象限活检监测的诊断准确性。患者和方法：最初入组的200例Barrett食管患者中，共有187例（73%男性，平均年龄67岁，平均Barrett食管段长度4.6 cm），在4个研究中心接受了Barrett食管内镜检查，随机分配接受AFE靶向活检后四象限活检或常规内镜监测，也包括四象限活检（研究阶段1）。在排除了接受内镜或手术治疗的早期癌症或高度异型增生患者以及拒绝参加第2阶段研究的患者后，仍有130例患者。这些患者在平均10周后再次使用替代方法进行检查，使用相同的方法。主要研究参数是早期癌症/腺癌或高度异型增生（HGD）的检测，比较研究阶段1中的两种方法：阶段2的次要研究目的是评估常规监测后AFE引导方法的附加价值，反之亦然。结果：在第1期研究中，AFE和常规方法的腺癌/HGD发生率分别为12%和5.3%。使用AFE，确定了4个先前未识别的腺癌/HGD病变（4.3%的患者）;使用传统方法，确定了1个新病变（1.1%）。在研究第1阶段AFE内镜检查期间检测到的19个腺癌/HGD病变中，8个可见，而11个仅使用非靶向四象限活检检测到（灵敏度42%）。在组织学分类为非肿瘤性的766例活检中，58例可疑（特异性92%，阳性预测值12%，阴性预测值98.5%）。在研究阶段2，AFE检测到两个进一步的病变，除了最初的替代方法在3.2%的情况下，与一个病变与传统的内窥镜检查（1.7%）。结论：在这个转诊Barrett食管人群的肿瘤病变的患病率较高，AFE引导的方法提高了肿瘤的诊断率与传统的方法相比，使用四象限活检。然而，AFE单独不适合取代标准的四象限活检方案。
Background and study aims: The reference surveillance method in patients with Barrett's esophagus is careful endoscopic observation, with targeted as well as random four-quadrant biopsies. Autofluorescence endoscopy (AFE) may make it easier to locate neoplasia. The aim of this study was to elucidate the diagnostic accuracy of surveillance with AFE-guided plus four-quadrant biopsies in comparison with the conventional approach.Patients and methods: A total of 187 of 200 consecutive Barrett's esophagus patients who were initially enrolled (73 % male, mean age 67 years, mean Barrett's segment length 4.6 cm), who underwent endoscopy for Barrett's esophagus in four study centers, were randomly assigned to undergo either AFE-targeted biopsy followed by four-quadrant biopsies or conventional endoscopic surveillance, also including four-quadrant biopsies (study phase 1). After exclusion of patients with early cancer or high-grade dysplasia, who underwent endoscopic or surgical treatment, as well as those who declined to participate in phase 2 of the study, 130 patients remained. These patients were examined again with the alternative method after a mean of 10 weeks, using the same methods described. The main study parameter was the detection of early cancer/adenocarcinoma or high-grade dysplasia (HGD), comparing both approaches in study phase 1: the secondary study aim in phase 2 was to assess the additional value of the AFE-guided approach after conventional surveillance, and vice versa. Test accuracy measures were derived from study phase 1.Results: In study phase 1, the AFE and conventional approaches yielded adenocarcinoma/HGD rates of 12% and 5.3%, respectively, on a per-patient basis. With AFE, four previously unrecognized adenocarcinoma/HGD lesions were identified (4.3% of the patients); with the conventional approach, one new lesion (1.1%) was identified. Of the 19 adenocarcinoma/HGD lesions detected during AFE endoscopy in study phase 1, eight were visualized, while 11 were only detected using untargeted four-quadrant biopsies (sensitivity 42%). Of the 766 biopsies classified at histology as being nonneoplastic, 58 appeared suspicious (specificity 92%, positive predictive value 12%, negative predictive value 98.5%). In study phase 2, AFE detected two further lesions in addition to the initial alternative approach in 3.2% of cases, in comparison with one lesion with conventional endoscopy (1.7%).Conclusions: In this referral Barrett's esophagus population with a higher prevalence of neoplastic lesions, the AFE-guided approach improved the diagnostic yield for neoplasia in comparison with the conventional approach using four-quadrant biopsies. However, AFE alone was not suitable for replacing the standard four-quadrant biopsy protocol.