Can an endocytoscope system (ECS) predict histology in neoplastic lesions?
Can an endocytoscope system (ECS) predict histology in neoplastic lesions?
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DOI：
10.1055/s-2007-966446
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发表时间：
2007-06-01
期刊：
影响因子：
9.3
通讯作者：
Messmann, H.
中科院分区：
文献类型：
--
作者：
Eberl, T.;Jechart, G.;Messmann, H.
背景和研究进展：最近开发的一种内窥镜系统(ECS)可以对胃肠道粘膜进行超高倍放大，从而可以对活细胞进行活体成像。本研究的目的是评估ECS在预测正常胃肠道粘膜和肿瘤病变的组织学方面的潜力。患者和方法：共有76例(男性57例，女性19例；年龄37-86岁)在食道、胃或结肠肿瘤病变中入选研究，并接受了食道胃十二指肠镜或结肠镜检查。1%亚甲蓝染色后，用ECS探针(x 450和x 1100倍率)检查粘膜，并将视频序列记录在视频光盘上。从检查区域取活组织作组织学检查，作为金标准。两名盲人病理学家对内窥镜视频序列进行了评估。结果：共检查食道病变25例，结肠病变28例，胃病变23例。盲人病理学家评价食道、胃、结肠的灵敏度和特异度分别为81%和100%、56%和89%、79%和90%。如果内窥镜医师结合宏观内窥镜图像对内窥镜图像进行评估，则敏感性和特异性显着增加。结论：首先，ECS经验对食道和结肠病变具有良好的敏感性，即使在盲法评估的情况下也是如此。由于胃粘液的分泌，对胃肿瘤病变的敏感性较低。结合病变的内窥镜和细胞镜表现，可进一步提高该方法的诊断价值。
Background and study alms: An endocytoscope system (ECS) has recently been developed with the possibility of super-high magnification of gastrointestinal mucosa, thus allowing in vivo imaging of living cells. The aim of the present study was to assess the potential of ECS in the prediction of histology in both normal gastrointestinal mucosa and neoplastic lesions.Patients and methods: In total, 76 patients (57 men, 19 women; age range 37-86 years) with neoplastic lesions in the esophagus, stomach, or colon were enrolled into the study and underwent esophagogastroduodenoscopy or colonoscopy. After staining with 1 % methylene blue, the mucosa was examined with the ECS probe (x 450 and x 1100 magnification), and video sequences were recorded on video disk. Biopsies from the examined areas were taken for histology and served as the gold standard. The endocytoscope video sequences were evaluated by two blinded pathologists. Finally the results were compared with those resulting from the evaluation of an experienced endoscopist who was aware of the macroscopic endoscopic pictures and the endocytoscope image results.Results: A total of 25 patients with esophageal lesions, 28 patients with colonic lesions, and 23 patients with gastric lesions were examined. The sensitivity and specificity for the evaluation of the blinded pathologists was 81% and 100%, respectively, in the esophagus, 56% and 89% in the stomach, and 79% and 90% in the colon. If an endoscopist evaluated the endocytoscopic pictures in combination with the macroscopic endoscopic images sensitivity and specificity increased significantly.Conclusions: First experiences with ECS show good sensitivity rates even by blinded assessment for esophageal and colonic lesions. Sensitivity for neoplastic lesions in the stomach is lower because of gastric mucous secretion. Combining the endoscopic and cytoscopic appearance of the lesion may further enhance the diagnostic value of the method.