Kendall Catherine, Stone Nicholas, Shepherd Neil, Geboes Karel, Warren Bryan, Bennett Robert, Barr Hugh
Cranfield Postgraduate Medical School, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
J Pathol. 2003 Aug;200(5):602-9. doi: 10.1002/path.1376.
Histopathology remains the gold standard technique for the diagnosis of intraepithelial neoplasia (dysplasia) in Barrett's oesophagus, but it is highly subjective and relies on blind biopsy targeting. The aim of this study was to evaluate Raman spectroscopy, a rapid, non-invasive, molecular, specific analytical technique, for the objective identification and classification of Barrett's neoplasia in vitro. A secondary objective was to demonstrate the need for a rigorous gold standard in the development of new diagnostic techniques. Forty-four patients with a mean age of 69 years (range 34-89 years) undergoing surveillance for Barrett's oesophagus were included in the study. Three consultant pathologists independently assessed snap-frozen oesophageal biopsy specimens. Raman spectra were measured on 87 histopathologically homogeneous samples. Spectral classification models were developed using multivariate analysis for the prediction of pathology. Histopathology and Raman classification results were compared. Raman spectral prediction with a consensus pathology classification model gave sensitivities between 73% and 100% and specificities of 90-100%. A high level of agreement (kappa = 0.89) was demonstrated between the three-subset biopsy targeting model and consensus pathology opinion. This compares favourably with the agreement measured between an independent pathologist and the consensus pathology opinion for the same spectra (kappa = 0.76). Raman spectroscopy appears to provide a highly sensitive and specific technique for the identification and classification of neoplasia in Barrett's oesophagus.
组织病理学仍然是诊断巴雷特食管上皮内瘤变（发育异常）的金标准技术，但它主观性很强，且依赖于盲目活检定位。本研究的目的是评估拉曼光谱法，这是一种快速、无创、分子特异性分析技术，用于在体外对巴雷特瘤变进行客观识别和分类。第二个目的是证明在开发新诊断技术时需要严格的金标准。44名平均年龄为69岁（范围34 - 89岁）接受巴雷特食管监测的患者被纳入研究。三名顾问病理学家独立评估速冻食管活检标本。在87个组织病理学上同质的样本上测量拉曼光谱。使用多变量分析开发光谱分类模型以预测病理情况。比较组织病理学和拉曼分类结果。使用共识病理分类模型进行拉曼光谱预测的敏感性在73%至100%之间，特异性为90 - 100%。三子集活检定位模型与共识病理意见之间显示出高度一致性（kappa = 0.89）。这与独立病理学家和针对相同光谱的共识病理意见之间测量的一致性（kappa = 0.76）相比更具优势。拉曼光谱法似乎为巴雷特食管瘤变的识别和分类提供了一种高度敏感和特异的技术。
