弹性散射光谱术能准确检测出巴雷特食管中的高级别发育异常和癌症。
Elastic scattering spectroscopy accurately detects high grade dysplasia and cancer in Barrett's oesophagus.
作者信息
Lovat L B, Johnson K, Mackenzie G D, Clark B R, Novelli M R, Davies S, O'Donovan M, Selvasekar C, Thorpe S M, Pickard D, Fitzgerald R, Fearn T, Bigio I, Bown S G
机构信息
National Medical Laser Centre, Department of Surgery, Royal Free and University College Medical School, University College London, UK.
出版信息
Gut. 2006 Aug;55(8):1078-83. doi: 10.1136/gut.2005.081497. Epub 2006 Feb 9.
BACKGROUND AND AIMS
Endoscopic surveillance of Barrett's oesophagus currently relies on multiple random biopsies. This approach is time consuming, has a poor diagnostic yield, and significant interobserver variability. Elastic scattering spectroscopy is a real time in vivo optical technique which detects changes in the physical properties of cells. The aim of this study was to assess the potential for elastic scattering to detect high grade dysplasia or cancer within Barrett's oesophagus.
METHODS
Elastic scattering spectroscopy measurements collected in vivo were matched with histological specimens taken from identical sites within Barrett's oesophagus. All biopsies were reviewed by three gastrointestinal pathologists and defined as either "low risk" (non-dysplastic or low grade dysplasia) or "high risk" (high grade dysplasia or cancer). Two different statistical approaches (leave one out and block validation) were used to validate the model.
RESULTS
A total of 181 matched biopsy sites from 81 patients, where histopathological consensus was reached, were analysed. There was good pathologist agreement in differentiating high grade dysplasia and cancer from other pathology (kappa = 0.72). Elastic scattering spectroscopy detected high risk sites with 92% sensitivity and 60% specificity and differentiated high risk sites from inflammation with a sensitivity and specificity of 79%. If used to target biopsies during endoscopy, the number of low risk biopsies taken would decrease by 60% with minimal loss of accuracy. A negative spectroscopy result would exclude high grade dysplasia or cancer with an accuracy of >99.5%.
CONCLUSIONS
These preliminary results show that elastic scattering spectroscopy has the potential to target conventional biopsies in Barrett's surveillance saving significant endoscopist and pathologist time with consequent financial savings. This technique now requires validation in prospective studies.
背景与目的
目前，巴雷特食管的内镜监测依赖于多次随机活检。这种方法耗时、诊断率低且观察者间差异显著。弹性散射光谱是一种实时体内光学技术，可检测细胞物理特性的变化。本研究的目的是评估弹性散射检测巴雷特食管内高级别异型增生或癌症的潜力。
方法
将体内收集的弹性散射光谱测量结果与取自巴雷特食管相同部位的组织学标本进行匹配。所有活检标本由三位胃肠病理学家进行评估，并分为“低风险”（无异型增生或低级别异型增生）或“高风险”（高级别异型增生或癌症）。使用两种不同的统计方法（留一法和分组验证）对模型进行验证。
结果
对81例患者共181个达成组织病理学共识的匹配活检部位进行了分析。在区分高级别异型增生和癌症与其他病理情况方面，病理学家之间具有良好的一致性（kappa = 0.72）。弹性散射光谱检测高风险部位的灵敏度为92%，特异度为60%，区分高风险部位与炎症的灵敏度和特异度分别为79%。如果在内镜检查期间用于指导活检，低风险活检的数量将减少60%，而准确性损失最小。光谱检查结果为阴性可排除高级别异型增生或癌症，准确性>99.5%。
结论
这些初步结果表明，弹性散射光谱有潜力在巴雷特监测中指导传统活检，节省内镜医师和病理学家的大量时间，从而节省费用。该技术目前需要在前瞻性研究中进行验证。
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