Elastic scattering spectroscopy accurately detects high grade dysplasia and cancer in Barrett's oesophagus
Elastic scattering spectroscopy accurately detects high grade dysplasia and cancer in Barrett's oesophagus
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DOI：
10.1136/gut.2005.081467
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发表时间：
2006-08-01
期刊：
影响因子：
24.5
通讯作者：
Bown, S. G.
中科院分区：
文献类型：
--
作者：
Lovat, L. B.;Johnson, K.;Bown, S. G.
背景和目的：巴雷特食管的内窥镜监测目前依赖于多次随机活检。这种方法耗时、诊断率低且观察者间差异显着。弹性散射光谱是一种实时体内光学技术，可检测细胞物理特性的变化。本研究的目的是评估弹性散射检测巴雷特食管内高度不典型增生或癌症的潜力。方法：将体内收集的弹性散射光谱测量值与取自巴雷特食管内相同部位的组织学标本进行匹配。所有活检均由三名胃肠病理学家进行审查，并定义为“低风险”（非发育不良或低度发育不良）或“高风险”（高度发育不良或癌症）。使用两种不同的统计方法（留一法和块验证）来验证模型。结果：分析了来自 81 名患者的总共 181 个匹配的活检部位，在这些部位达成了组织病理学共识。病理学家在区分高度不典型增生和癌症与其他病理学方面达成了良好的一致（kappa = 0.72）。弹性散射光谱以 92% 的灵敏度和 60% 的特异性检测高风险部位，并以 79% 的灵敏度和特异性区分高风险部位和炎症。如果在内窥镜检查期间用于目标活检，低风险活检的数量将减少 60%，而准确性损失最小。阴性光谱结果将排除高度不典型增生或癌症，准确度 > 99.5%。结论：这些初步结果表明，弹性散射光谱有可能在 Barrett 的监测中针对传统活检，从而节省大量内窥镜医师和病理学家的时间，从而节省资金。这项技术现在需要前瞻性研究的验证。
Background and aims: Endoscopic surveillance of Barrett's oesophagus currently relies on multiple random biopsies. This approach is time consuming, has a poor diagnostic yield, and significant interobserver variability. Elastic scattering spectroscopy is a real time in vivo optical technique which detects changes in the physical properties of cells. The aim of this study was to assess the potential for elastic scattering to detect high grade dysplasia or cancer within Barrett's oesophagus.Methods: Elastic scattering spectroscopy measurements collected in vivo were matched with histological specimens taken from identical sites within Barrett's oesophagus. All biopsies were reviewed by three gastrointestinal pathologists and defined as either "low risk'' (non-dysplastic or low grade dysplasia) or "high risk'' (high grade dysplasia or cancer). Two different statistical approaches (leave one out and block validation) were used to validate the model.Results: A total of 181 matched biopsy sites from 81 patients, where histopathological consensus was reached, were analysed. There was good pathologist agreement in differentiating high grade dysplasia and cancer from other pathology (kappa = 0.72). Elastic scattering spectroscopy detected high risk sites with 92% sensitivity and 60% specificity and differentiated high risk sites from inflammation with a sensitivity and specificity of 79%. If used to target biopsies during endoscopy, the number of low risk biopsies taken would decrease by 60% with minimal loss of accuracy. A negative spectroscopy result would exclude high grade dysplasia or cancer with an accuracy of > 99.5%.Conclusions: These preliminary results show that elastic scattering spectroscopy has the potential to target conventional biopsies in Barrett's surveillance saving significant endoscopist and pathologist time with consequent financial savings. This technique now requires validation in prospective studies.