Bourg-Heckly G, Blais J, Padilla J J, Bourdon O, Etienne J, Guillemin F, Lafay L
Laboratoire de Physicochimie Biomoléculaire et Cellulaire, Université Pierre et Marie Curie, Paris, France.
Endoscopy. 2000 Oct;32(10):756-65. doi: 10.1055/s-2000-7704.
Endoscopic identification of dysplasia and early carcinoma of the esophagus is difficult and is currently done through random pinch biopsies. This study assesses the potential of ultraviolet-induced autofluorescence spectroscopy for early diagnosis with special focus on Barrett's esophagus.
Measurements were performed on 24 patients using 330 nm light excitation. The determination of the spectral distribution typical of each histological tissue type was done using three fluorescence intensity ratios: RI = I390nm/I450nm; R2 = I550nm/I450nm; R3 - I390nm/I550nm.
The spectral distribution of normal esophageal mucosa and specialized columnar Barrett's mucosa were similar. A strong modification of the spectral distribution was observed for high grade dysplasia and intramucosal carcinoma. Statistical analysis indicated that the spectral shape modification associated with neoplastic transformation was greater than intra- and interpatient spectral variations. These results allow the determination of discriminating criteria based on ratios R1 and R3. Using ratio R3, the spectroscopy-based diagnosis differentiated neoplastic tissue from normal esophageal mucosa and specialized columnar Barrett's mucosa with a sensitivity and specificity of 86% and 95 %, respectively.
The use of ultraviolet autofluorescence spectroscopy should improve the diagnostic yield of standard endoscopy in patients with Barrett's esophagus.
内镜下鉴别食管发育异常和早期癌很困难，目前通过随机钳取活检来进行。本研究评估紫外线诱导自体荧光光谱在早期诊断中的潜力，特别关注巴雷特食管。
对24例患者使用330nm光激发进行测量。通过三个荧光强度比来确定每种组织学类型典型的光谱分布：RI = I390nm/I450nm；R2 = I550nm/I450nm；R3 = I390nm/I550nm。
正常食管黏膜和特殊柱状巴雷特黏膜的光谱分布相似。在高级别发育异常和黏膜内癌中观察到光谱分布有强烈改变。统计分析表明，与肿瘤转化相关的光谱形状改变大于患者内和患者间的光谱变化。这些结果允许基于R1和R3比值确定鉴别标准。使用R3比值，基于光谱的诊断将肿瘤组织与正常食管黏膜和特殊柱状巴雷特黏膜区分开来，敏感性和特异性分别为86%和95%。
紫外线自体荧光光谱的应用应能提高巴雷特食管患者标准内镜检查的诊断率。
