In vivo histology of Barrett's esophagus and associated neoplasia by confocal laser endomicroscopy
In vivo histology of Barrett's esophagus and associated neoplasia by confocal laser endomicroscopy
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DOI：
10.1016/j.cgh.2006.05.010
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发表时间：
2006-08-01
影响因子：
12.6
通讯作者：
Neurath, Markus F.
中科院分区：
文献类型：
--
作者：
Kiesslich, Ralf;Gossner, Liebwin;Neurath, Markus F.
背景与目的：共聚焦激光显微内镜可以在内镜检查过程中对肠粘膜和体内组织学进行亚表面分析。在这里，我们已经应用这种技术在体内诊断巴雷特上皮和相关的肿瘤。方法：应用显微内镜对食管下段进行全柱型扫描。将在柱状食管下段1 cm范围内获得的图像数字化存储，并对检查区域进行靶向活检检查或内镜粘膜切除。体内组织学与组织学标本进行比较。所有数字存储的图像由盲法研究者通过共焦Barrett分类系统重新评估，以预测组织学。使用K统计量评估参与内镜医师的观察者内和观察者间差异。结果如下：在63例患者进行内镜检查期间，显微内镜检查可以区分不同类型的上皮细胞，并以高分辨率检测Barrett上皮细胞和血管变化。Barrett食管和相关肿瘤的预测敏感性分别为98.1%和92.9%，特异性分别为94.1%和98.4%（准确性分别为96.8%和97.4%）。观察者间预测组织病理学诊断一致性的平均kappa值为0.843，而观察者内一致性的平均kappa值为0.892。结论：Barrett食管的内窥镜辅助显微内镜检查允许在进行内窥镜检查期间对粘膜层进行体内组织学检查。胃和Barrett上皮和Barrett相关的肿瘤变化可以以高准确性诊断。因此，显微内镜检查可能有助于巴雷特食管患者的管理。
Background & Aims: Confocal laser endomicroscopy allows subsurface analysis of the intestinal mucosa and in vivo histology during ongoing endoscopy. Here, we have applied this technique to the in vivo diagnosis of Barrett's epithelium and associated neoplasia. Methods: Fluorescein-aided endomicroscopy was performed by applying the endomicroscope over the whole columnar-lined lower esophagus. Images obtained within 1 cm of the columnar-lined lower esophagus were stored digitally and a targeted biopsy examination or endoscopic mucosal resection of the examined areas was performed. In vivo histology was compared with the histologic specimens. All digitally stored images were re-assessed by a blinded investigator by the confocal Barrett classification system to predict histology. Intraobserver and interobserver variations of the involved endoscopists were evaluated by using K statistics. Results: Endomicroscopy allowed distinguishing between different types of epithelial cells and detected cellular and vascular changes in Barrett's epithelium at high resolution during ongoing endoscopy in 63 patients. Barrett's esophagus and associated neoplasia could be predicted with a sensitivity of 98.1% and 92.9% and a specificity of 94.1% and 98.4%, respectively (accuracy, 96.8% and 97.4%). The mean kappa value for interobserver agreement for the prediction of histopathological diagnosis was .843, whereas the intraobserver agreement showed a mean kappa value of .892. Conclusions: Fluorescence-aided endomicroscopy of Barrett's esophagus allows in vivo histology of the mucosal layer during ongoing endoscopy. Gastric and Barrett's epithelium and Barrett's-associated neoplastic changes can be diagnosed with high accuracy. Thus, endomicroscopy may be helpful in the management of patients with Barrett's esophagus.