Using Laser Raman Spectroscopy to Reduce False Positives of Autofluorescence Bronchoscopies: A Pilot Study
Using Laser Raman Spectroscopy to Reduce False Positives of Autofluorescence Bronchoscopies: A Pilot Study
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DOI：
10.1097/jto.0b013e3182178ef7
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发表时间：
2011-07
影响因子：
20.4
通讯作者：
M. Short;S. Lam;A. Mcwilliams;D. Ionescu;H. Zeng
中科院分区：
文献类型：
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作者：
M. Short;S. Lam;A. Mcwilliams;D. Ionescu;H. Zeng
前言：支气管树癌前病变发展为恶性肿瘤的可能性很高。目前，最好的定位方法是白光支气管镜(WLB)和自体荧光支气管镜(AFB)相结合(WLB+AFB)。这种联合检测方法在大型临床试验中的平均特异度约为60%，导致许多假阳性。本研究的目的是确定在WLB+AFB中加入点激光拉曼光谱(LRS)是否有可能提高癌前病变检测的特异性，以及这对检测灵敏度有何意义。方法：开发了一种LRS系统，通过将光纤导管沿支气管镜的仪器通道向下传递，实时采集活体肺光谱。使用WLB+AFB成像方式识别26个受试者的皮损，从中测量129个拉曼光谱。对光谱进行多变量统计分析，采用留一法交叉验证。结果：1秒内即可获得清晰的体内拉曼光谱。光谱中单个拉曼峰的位置与脂类、蛋白质和水分子产生的拉曼峰的已知位置有很好的相关性。检出癌前病变的敏感性为96%，特异性为91%。结论：在WLB+AFB显像中加入点LRS分析，可实时发现癌前病变，具有较高的敏感性和特异性。LRS的使用具有极大的潜力，可以在几乎不降低检测灵敏度的情况下大幅减少与WLB+AFB相关的假阳性活检的数量。
Introduction: Preneoplastic lesions of the bronchial tree have a high probability of developing into malignant tumors. Currently, the best method for localizing them for further treatment is a combined white light bronchoscopy (WLB) and autofluorescence bronchoscopy (AFB) (WLB + AFB). The average specificity from large clinical trials for this combined detection method is approximately 60%, leading to many false positives. The object of this study is to determine whether adding point laser Raman spectroscopy (LRS) to a WLB + AFB has the potential to improve the specificity of preneoplastic lesion detection and what the implication is to the detection sensitivity. Methods: An LRS system was developed to collect real-time, in vivo lung spectra with a fiber optic catheter passed down the instrument channel of a bronchoscope. WLB + AFB imaging modalities were used to identify lesions from 26 subjects, from which 129 Raman spectra were measured. Multivariate statistical analyses were performed on the spectra with a leave-one-out crossvalidation. Results: Clear in vivo Raman spectra were obtained in 1 second. The location of individual Raman peaks in the spectra correlated well with the known positions of Raman peaks generated by lipids, proteins, and water molecules. Preneoplastic lesions were detected with a sensitivity of 96% and a specificity of 91%. Conclusion: Adding point LRS analysis to WLB + AFB imaging has the ability to detect preneoplastic lesions in real time with high sensitivity and specificity. The use of LRS has great potential for substantially reducing the number of false-positive biopsies associated with WLB + AFB with very little reduction in the detection sensitivity.