Arens C, Reussner D, Neubacher H, Woenckhaus J, Glanz H
Department of Otorhinolaryngology, University Hospitals, Feulgenstrasse 10, 35385 Giessen, Germany.
Eur Arch Otorhinolaryngol. 2006 Nov;263(11):1001-7. doi: 10.1007/s00405-006-0099-6. Epub 2006 Aug 31.
Only early diagnosis of laryngeal cancer can prevent major or mutilating treatment. Recently, autofluorescence endoscopy has been developed to enhance endoscopic information and succeeded in facilitating the detection and demarcation of precancerous lesions, carcinoma in situ and cancer of the larynx. The aim of the present study is to quantify autofluorescence imaging by spectroscopy in order to validate the above mentioned findings. In a prospective study, 42 patients with suspected one-sided precancerous or cancerous lesions of the vocal folds were investigated during microlaryngoscopy. Autofluorescence (AF) was induced by filtered blue light (375-440 nm) of a xenon short arc lamp and processed by a CCD camera system (D-light AF System, STORZ, Germany). Autofluorescence images were gathered in a contact mode. For spectrometric measurements an optical multi channel analyzer (AVS-USB 2000, Avantes, The Netherlands) was applied. The results were compared to pathohistological findings. Under blue light excitation normal mucosa presented a bright green fluorescence. Intensity increased from the ventricular folds to the subglottic area. Averaged spectra of the normal laryngeal mucosa demonstrated different fluorescence maxima at 475, 515, 550, 600 and 630 nm. Highest intensity was measured at 515 nm explaining the green appearance of the autofluorescence picture. In contrast, precancerous as well as cancerous lesions showed a significant decrease in autofluorescence intensity with a reddish-violet color. Highest loss of autofluorescence intensity was measured at 515 nm. At this wave length intensity dropped 70% on average in comparison to the regularly appearing contralateral vocal fold. In contrast to 515 nm, the loss of intensity at 630 nm amounted to 38%. Sensitivity amounted to 97% and specificity to 82%. Comparable to autofluorescence endoscopy a differentiation between precancerous and cancerous lesions could not be detected. The reason for the loss of autofluorescence may predominantly be caused by mucosal thickening but also by changes in metabolism and higher nuclei density.
只有早期诊断喉癌才能避免进行大型或致残性治疗。近年来，自体荧光内镜已得到发展，以增强内镜检查信息，并成功促进了癌前病变、原位癌和喉癌的检测与边界划定。本研究的目的是通过光谱法定量自体荧光成像，以验证上述发现。在一项前瞻性研究中，对42例疑似单侧声带癌前或癌性病变的患者在显微喉镜检查期间进行了研究。自体荧光（AF）由氙短弧灯的滤过蓝光（375 - 440 nm）激发，并由电荷耦合器件相机系统（D-light AF System，STORZ，德国）处理。自体荧光图像以接触模式采集。为进行光谱测量，应用了光学多通道分析仪（AVS - USB 2000，Avantes，荷兰）。将结果与病理组织学结果进行比较。在蓝光激发下，正常黏膜呈现亮绿色荧光。强度从室襞到声门下区域增加。正常喉黏膜的平均光谱在475、515、550、600和630 nm处显示出不同的荧光最大值。在515 nm处测量到最高强度，这解释了自体荧光图像的绿色外观。相比之下，癌前病变和癌性病变的自体荧光强度显著降低，呈现红紫色。在515 nm处测量到自体荧光强度的最大损失。与正常对侧声带相比，在此波长下强度平均下降70%。与515 nm相反，630 nm处的强度损失为38%。灵敏度为97%，特异性为82%。与自体荧光内镜检查类似，无法检测到癌前病变和癌性病变之间的差异。自体荧光损失的原因可能主要是黏膜增厚，但也可能是代谢变化和细胞核密度增加所致。
