Diagnostic value of confocal laser endomicroscopy for gastric superficial cancerous lesions
Diagnostic value of confocal laser endomicroscopy for gastric superficial cancerous lesions
复制标题
共聚焦激光内镜对胃浅表癌性病变的诊断价值
DOI：
10.1136/gut.2010.223586
复制
发表时间：
2011-03-01
期刊：
影响因子：
24.5
通讯作者：
Li, Yan-Qing
中科院分区：
文献类型：
--
作者：
Li, Wen-Bo;Zuo, Xiu-Li;Li, Yan-Qing
背景基于传统白光内窥镜(WLE)的胃浅表性癌病变的识别是具有挑战性的，组织学分析仍然是最终诊断的金标准。激光共聚焦显微镜(CLE)可以提供活体组织学观察，而不需要活检。目的建立和评价胃浅表癌病变的CLE成像标准，并比较实时积分激光内窥镜(ICLE)和WLE单独应用对胃浅表癌病变的诊断价值。设计前瞻性研究。研究对象：山东大学济南齐鲁医院，共182例患者进入I期，1786例患者进入II期。干预：在I期胃镜检查后，对CLE图像进行盲法评价。结果离线诊断早期胃癌具有较高的敏感性(88.1%)和特异性(98.6%)。当引入非癌病变和癌/高级别上皮内瘤变(HGIN)病变的两级CLE分类时，CLE诊断的敏感度(90.2%)和特异度(98.5%)较高(I期)。实时ICLE诊断胃浅表癌/HGIN病变的敏感性(88.9%)、特异性(99.3%)和准确性(98.8%)高于WLE诊断(敏感性72.2%；特异性95.1%；准确性94.1%)(p
Background The identification of gastric superficial cancerous lesions based on conventional white-light endoscopy (WLE) is challenging, and histological analysis remains the 'gold standard' for the final diagnosis. Confocal laser endomicroscopy (CLE) can provide in vivo histological observation without the need for biopsy.Objective To develop and evaluate CLE imaging criteria for gastric superficial cancerous lesions and to compare the diagnostic value of real-time integrated CLE (iCLE) and WLE alone in distinguishing gastric superficial cancerous lesions.Design Prospective study.Setting Qilu Hospital, Shandong University, Jinan, China.Patients A total of 182 patients were enrolled into phase I and 1786 patients were enrolled into phase II.Interventions CLE images were blindly evaluated after endoscopy in phase I, and real-time iCLE diagnosis during endoscopy was compared with WLE diagnosis by using histopathology as a gold standard in phase II.Main outcome measurements The validity and reliability of the CLE diagnosis for identifying gastric superficial cancerous lesions.Results Off-line CLE diagnosis for early gastric cancers had a high sensitivity (88.1%) and specificity (98.6%). When the two-tiered CLE classification of non-cancerous lesions and cancer/high-grade intraepithelial neoplasia (HGIN) lesions was introduced, CLE diagnosis led to a higher sensitivity (90.2%) and specificity (98.5%) (phase I). Real-time iCLE diagnosis had a higher sensitivity (88.9%), specificity (99.3%) and accuracy (98.8%) for gastric superficial cancer/HGIN lesions than WLE diagnosis (sensitivity, 72.2%; specificity, 95.1%; and accuracy, 94.1%) (p