The use of cytokeratin stain to distinguish Barrett's esophagus from contiguous tissues: A systematic review
The use of cytokeratin stain to distinguish Barrett's esophagus from contiguous tissues: A systematic review
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DOI：
10.1007/s10620-006-9399-3
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发表时间：
2007-05-01
影响因子：
3.1
通讯作者：
El-Serag, Hashem B.
中科院分区：
文献类型：
--
作者：
Nurgalieva, Zhannat;Lowrey, Angus;El-Serag, Hashem B.
我们的目的是系统地回顾关于使用细胞角蛋白 (CK) 染色区分巴雷特食管 (BE) 与贲门、胃体或胃窦组织（伴或不伴肠化生 (IM)）的现有文献。在 Pubmed 中搜索了完整的英文出版物（1983-2005），内容涉及使用 CK 来区分邻近组织中的 BE。收集有关研究样本、盲法、CK 染色方法以及定义和应用金标准测试的信息。获得或计算测试特性。 16 项研究（包含 46 项比较）符合纳入和排除标准。 CK 7 和 20 的免疫染色在区分长段 BE 与胃窦 IM、眼底 IM 或非贲门胃 IM 方面通常具有高度特异性； 27 项比较显示出统计上显着的差异。然而，15 项比较中只有 8 项（12 项研究中的 6 项）报告了 BE 和贲门 IM 之间 CK 染色模式的显着差异，对长段 BE 具有高敏感性（89%-100%）和特异性（83%-100%），对短段 BE 的估计值较低，而其他 7 项比较显示没有显着差异且敏感性非常低。六项阳性研究中有五项报告了由盲法病理学家进行的检查，而六项阴性研究中只有一项报告了由盲法病理学家进行的检查。此外，患者群体的差异、手术切除与内窥镜活检的使用以及内窥镜研究中活检取样技术可能是造成这些差异的原因。最后，两项研究没有发现BE和正常心脏粘膜之间的CK染色模式存在显着差异。总之，CK 免疫染色在区分 BE（尤其是短节段 BE）与贲门 IM 方面表现不佳。似乎存在频谱偏差，其准确度随不同测试人群的不同而变化。 CK 免疫染色可以很好地区分胃非贲门部分的 BE 和 IM；然而，这些比较没有临床意义。
Our objective was to systematically review the existing literature regarding the use of cytokeratin (CK) stain in differentiating Barrett's esophagus (BE) from tissues of the gastric cardia, corpus, or antrum, with or without intestinal metaplasia (IM). Pubmed was searched for full publications in English (1983-2005) addressing the use of CK for differentiation of BE from contiguous tissues. Information was collected on the study sample, blinding, the methods used for CK staining, and for defining and applying the gold standard tests. Test characteristics were obtained or calculated. Sixteen studies (containing 46 comparisons) met the inclusion and exclusion criteria. Immunostaining for CK 7 and 20 was generally highly specific in distinguishing long-segment BE from antrum IM, fundus IM, or noncardiac gastric IM; 27 comparisons showed statistically significant differences. However, only 8 of 15 comparisons (6 of 12 studies) reported significant differences in CK staining patterns between BE and gastric cardia IM with a high sensitivity (89%-100%) and specificity (83%-100%) for long-segment BE and lower estimates for short-segment BE, while the other seven comparisons showed no significant differences and a very low sensitivity. Examination by a blinded pathologist was reported in five of six positive studies and in only one of six of the negative studies. In addition, variation in the patient populations, use of surgical resection versus endoscopic biopsies, and biopsy sampling technique in endoscopic studies may have accounted for these differences. Finally, two studies did not find significant differences in CK staining patterns between BE and normal cardiac mucosa. In conclusions, CK immunostaining has not performed well in differentiating BE, especially short-segment BE, from cardia IM. There seems to be a spectrum bias where the accuracy varies with different tested populations. CK immunostaining distinguished well between BE and IM in noncardiac segments of the stomach; however, these comparisons are not clinically relevant.