Poneros J M, Brand S, Bouma B E, Tearney G J, Compton C C, Nishioka N S
Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Gastroenterology. 2001 Jan;120(1):7-12. doi: 10.1053/gast.2001.20911.
Optical coherence tomography (OCT) is an imaging technique that produces high-resolution cross-sectional images in vivo. The aim of this study was to establish the sensitivity and specificity of OCT for diagnosing specialized intestinal metaplasia (SIM).
OCT was used to image the stomach and esophagus of 121 patients. A total of 288 biopsy-correlated OCT images were acquired. OCT criteria for SIM were formulated by analyzing 75 images of SIM. The SIM image criteria were retrospectively tested by applying them to images of gastric, squamous, SIM, and cardiac epithelium. The criteria were then tested prospectively to determine the sensitivity and specificity of OCT for diagnosing SIM.
OCT images of SIM are characterized by (1) absence of the layered structure of normal squamous epithelium and the vertical "pit and crypt" morphology of gastric mucosa, (2) disorganized architecture with inhomogeneous tissue contrast and an irregular mucosal surface, and (3) presence of submucosal glands. These criteria were 100% sensitive and 93% specific for SIM when applied retrospectively and 97% sensitive and 92% specific when tested prospectively.
OCT is highly sensitive and specific for SIM and may aid in the diagnosis and surveillance of this preneoplastic lesion.
光学相干断层扫描（OCT）是一种能够在体内生成高分辨率横断面图像的成像技术。本研究的目的是确定OCT诊断特殊肠化生（SIM）的敏感性和特异性。
对121例患者的胃和食管进行OCT成像。共获取了288幅与活检相关的OCT图像。通过分析75幅SIM图像制定了SIM的OCT标准。将这些SIM图像标准应用于胃、鳞状上皮、SIM和贲门上皮的图像，进行回顾性测试。然后进行前瞻性测试，以确定OCT诊断SIM的敏感性和特异性。
SIM的OCT图像特征为：（1）缺乏正常鳞状上皮的分层结构和胃黏膜的垂直“隐窝和腺管”形态；（2）组织结构紊乱，组织对比度不均匀，黏膜表面不规则；（3）存在黏膜下腺体。这些标准在回顾性应用时对SIM的敏感性为100%，特异性为93%；在前瞻性测试时敏感性为97%，特异性为92%。
OCT对SIM具有高度敏感性和特异性，可能有助于这种癌前病变的诊断和监测。
