Confocal laser endomicroscopy for in vivo diagnosis of early squamous cell carcinoma in the esophagus
Confocal laser endomicroscopy for in vivo diagnosis of early squamous cell carcinoma in the esophagus
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DOI：
10.1016/j.cgh.2007.10.013
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发表时间：
2008-01-01
影响因子：
12.6
通讯作者：
Ell, Christian
中科院分区：
文献类型：
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作者：
Pech, Oliver;Rabenstein, Thomas;Ell, Christian
背景与目的：共聚焦激光显微内镜已被证明可以对体内胃肠道肿瘤进行直接的组织学成像。本研究旨在评估早期鳞状细胞癌患者常规内镜检查期间显微内镜在体内预测组织学的潜力。研究方法：21例疑似早期鳞状细胞癌的连续患者被转诊到三级医疗学术医疗中心进行内镜治疗，并被纳入这项前瞻性研究。用0.5%卢戈溶液染色并注射500 mg荧光素钠后，使用共聚焦成像检查未染色的粘膜区域。每个扫描病变的图像采集和数字存储，并在体内诊断进行内窥镜检查。从每个病变处取活检标本。共焦图像由2名内镜医师审查，他们对组织学和内镜外观不知情。结果：共聚焦成像获得了21例患者的43个病灶。43个病灶中的27个（63%）在组织学上被证明是鳞状细胞癌。所有鳞状细胞癌均通过显微内镜正确诊断，2个病变被误诊为肿瘤。总的准确性为95%，敏感性和特异性分别为100%和87%。观察者内一致性几乎完美（kappa = 0.95），观察者间一致性显著（kappa = 0.79）。结论：共聚焦激光显微内镜能够提供具有高度准确性的早期鳞状细胞癌的虚拟组织学，并且可以在常规内窥镜检查期间促进快速诊断。
Background & Aims: Confocal laser endomicroscopy has been shown to allow direct histologic imaging of gastrointestinal tumors in vivo. This study was designed to assess the potential of endomicroscopy for predicting histology in vivo during routine endoscopy in patients with early squamous cell cancer. Methods: Twenty-one consecutive patients with suspected early squamous cell cancer who had been referred for endoscopic therapy to a tertiary-care academic medical center were included in this prospective study. After staining with 0.5% Lugol's solution and injection of 500 mg fluorescein sodium, unstained mucosal areas were examined using confocal imaging. Images of each scanned lesion were acquired and stored digitally, and in vivo diagnosis was performed during ongoing endoscopy. Biopsy specimens were taken from every lesion. The confocal images were reviewed by 2 endoscopists, who were blinded to the histology and endoscopic appearance. Results: Confocal images were acquired from 43 lesions in 21 patients. Twenty-seven of the 43 lesions (63%) were proven to be squamous cell cancer on histology. All squamous cell cancers were diagnosed correctly by endomicroscopy and 2 lesions were falsely diagnosed as neoplastic. The overall accuracy was 95%, and the sensitivity and specificity were 100% and 87%, respectively. Intraobserver agreement was almost perfect (kappa = 0.95) and interobserver agreement was substantial (kappa = 0.79). Conclusions: Confocal laser endomicroscopy is able to provide virtual histology of early squamous cell cancers with a high degree of accuracy and can facilitate rapid diagnosis during routine endoscopy.