Accuracy of endoscopic optical coherence tomography in the detection of dysplasia in Barrett's esophagus: a prospective, double-blinded study
Accuracy of endoscopic optical coherence tomography in the detection of dysplasia in Barrett's esophagus: a prospective, double-blinded study
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DOI：
10.1016/j.gie.2005.07.048
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发表时间：
2005-12-01
影响因子：
7.7
通讯作者：
Rollins, A
中科院分区：
文献类型：
--
作者：
Isenberg, G;Sivak, MV;Rollins, A
背景资料：内窥镜光学相干断层扫描（EOCT）是一种高分辨率，横截面组织成像技术，提供微观形态信息。EOCT应检测Barrett上皮的发育异常，但这尚未在前瞻性盲法研究中确立。本研究评估的准确性EOCT的诊断和排除不典型增生的患者Barrett's esophageal.Methods：一个2.4毫米直径的EOCT探头进行了修改，使用帽安装，双通道内窥镜。获得成对的EOCT图像流和巨型活检标本。由4名内窥镜医生进行内窥镜检查/EOCT程序，他们分别审查EOCT数字图像，以确定获得的每份活检标本是否存在异型增生（低级别、高级别或癌症）。内镜医师对病理学解释不知情。由经验丰富的病理学家对内镜/EOCT结果设盲，评价每次活检是否存在异型增生。这项研究的背景是一个主要的学术医疗中心。成人患者记录Barrett食管大于2 cm的研究中包括的主要结果测量的准确性EOCT在与Barrett食管的患者异型增生的检测。结果：共314个可用的EOCT图像流/活检对获得33例。以组织学为标准，EOCT的表现为敏感性，68%，特异性，82%，阳性预测值，53%，阴性预测值，89%，诊断准确性，78%。4名内镜医师的诊断准确率范围为56%至98%。这项研究的局限性是内镜的准确率，难以实时解释的变化，并需要完善的标准发育不良EOCT imaging.Conclusions：目前的EOCT系统有一个准确性为78%的检测与巴雷特食管患者的发育不良。EOCT可用于靶向活检至存在异型增生的可能性较高的Barrett上皮区域。然而，在EOCT可用于临床之前，还需要进一步的修改，包括提高分辨率和识别发育不良的进一步潜在OCT特征。
Background: Endoscopic optical coherence tomography (EOCT) is a high-resolution, cross-sectional tissue-imaging technique that provides microscopic morphologic information. EOCT should detect dysplasia in Barrett's epithelium, but this has not been established in a prospective blinded study. This study evaluated the accuracy of EOCT for the diagnosis and the exclusion of dysplasia in patients with Barrett's esophagus.Methods: A 2.4-mm diameter EOCT probe was modified for use with a cap-fitted, two-channel endoscope. Pairs of EOCT image streams and jumbo biopsy specimens were obtained. Encloscopy/EOCT procedures were performed by 4 endoscopists who separately reviewed the EOCT digital images for the absence or the presence of dysplasia (low grade, high grade, or cancer) for each biopsy specimen obtained. The endoscopists were blinded to the interpretation of the pathology. An experienced pathologist blinded to the endoscopic/EOCT findings evaluated each biopsy for the absence or the presence.of dysplasia. The setting of the study was a major academic medical center. Adult patients with documented Barrett's esophagus greater than 2 cm were included in the study The main outcome measurement was the accuracy of EOCT in the detection of dysplasia in patients with Barrett's esophagus.Results: A total of 314 usable EOCT image stream/biopsy pairs were obtained in 33 patients. By using histology as the standard, the performance of EOCT was sensitivity, 68%; specificity, 82%; positive predictive value, 53%; negative predictive value, 89%; and diagnostic accuracy, 78%. Diagnostic accuracy for the 4 endoscopists ranged from 56% to 98%. Limitations of the study were the variability in endoscopists' accuracy rates, difficulty in real-time interpretation, and the need for refined criteria of dysplasia by EOCT imaging.Conclusions: The current EOCT system has an accuracy of 78% for the detection of dysplasia in patients with Barrett's esophagus. EOCT could he used to target biopsies to areas of Barrett's epithelium with a higher probability for the presence of dysplasia. However, further modifications, including increased resolution and identification of further potential OCT characteristics of dysplasia, are needed before EOCT can be used clinically.