Confocal laser endomicroscopy for in vivo diagnosis of gastric intraepithelial neoplasia: a feasibility study
Confocal laser endomicroscopy for in vivo diagnosis of gastric intraepithelial neoplasia: a feasibility study
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共聚焦激光内窥镜用于胃上皮内瘤变体内诊断：可行性研究
DOI：
10.1016/j.gie.2010.08.031
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发表时间：
2010-12-01
影响因子：
7.7
通讯作者：
Li, Yan-Qing
中科院分区：
文献类型：
--
作者：
Li, Zhen;Yu, Tao;Li, Yan-Qing
背景：共焦激光内窥镜（CLE）是一种新型内窥镜检查方式，可在正在进行的内窥镜检查过程中对胃粘膜进行表面下分析。多项研究报道该技术对胃肠道癌前病变的诊断具有价值，但尚未有研究报道其在胃上皮内瘤变（GIN）分析中的应用。 目的：评估 CLE 用于 GIN 识别和分级的可行性。设计：前瞻性双盲可行性研究。地点：中国济南山东大学齐鲁医院。患者：首先评估 33 名患者的 CLE 图像，以建立胃病变的诊断标准。然后使用新制定的标准对符合条件的患者进行 CLE 前瞻性调查。干预措施：通过 CLE 检查所有内镜可疑病变，并将 CLE 诊断与相应的组织病理学结果进行比较。主要结果测量：通过每个病灶分析，CLE 诊断活检证实的上皮内瘤变的敏感性、特异性以及阳性和阴性似然比。结果：CLE 诊断 GIN 的敏感性、特异性以及阳性和阴性似然比分别为 77.8%、81.8%、4.28 和 0.27。内窥镜医师诊断 GIN 的观察者间一致性的平均 kappa 值为 0.70，内窥镜医师和胃肠道病理学家之间的平均 kappa 值为 0.71。上皮内瘤变评分≥5分可区分高级别和低级别上皮内瘤变，敏感性为66.7%，特异性为88.0%。局限性：非随机单中心研究，患者数量有限。结论：CLE是一种可接受的、潜在有用的技术，可用于体内GIN的识别和分级。诊断准确性有待提高。 （胃肠道内镜检查 2010；72:1146-53）
Background: Confocal laser endomicroscopy (CLE) is a novel endoscopic modality that allows subsurface analysis of the gastric mucosa during ongoing endoscopy. Several studies have reported that this technique is of value in the diagnosis of premalignant lesions in the GI tract, but as yet no investigations have reported its application in the analysis of gastric intraepithelial neoplasia (GIN).Objective: To assess the feasibility of CLE for the identification and grading of GIN.Design: Prospective double-blind feasibility study.Setting: Qilu Hospital, Shandong University, Jinan, China.Patients: CLE images of 33 patients were first evaluated to establish the diagnostic criteria for gastric lesions. Eligible patients were then prospectively investigated by CLE using the newly established criteria.Interventions: All endoscopically suspicious lesions were examined by CLE, and CLE diagnoses were compared with corresponding histopathologic results.Main Outcome Measurements: Sensitivity, specificity, and positive and negative likelihood ratios of CLE diagnosis of biopsy-proven intraepithelial neoplasia by per-lesion analysis.Results: The sensitivity, specificity, and positive and negative likelihood ratios of CLE diagnosis of GIN were 77.8%, 81.8%, 4.28, and 0.27, respectively. The mean kappa value for interobserver agreement for the diagnosis of GIN was 0.70 among endoscopists and 0.71 between endoscopist and GI pathologist. Intraepithelial neoplasia score >= 5 differentiated high-grade from low-grade intraepithelial neoplasia with a sensitivity of 66.7% and a specificity of 88.0%.Limitations: Nonrandomized single-center study, limited number of patients.Conclusions: CLE is an acceptable and potentially useful technology for the identification and grading of GIN in vivo. The diagnostic accuracy needs to be improved. (Gastrointest Endosc 2010;72:1146-53)