Pohl H, Koch M, Khalifa A, Papanikolaou I S, Scheiner K, Wiedenmann B, Rösch T
Central Interdisciplinary Endoscopy Unit, Department of Gastroenterology, Campus Virchow, Berlin, Germany.
Endoscopy. 2007 Jun;39(6):492-6. doi: 10.1055/s-2007-966340.
Surveillance for patients with Barrett's esophagus is time consuming and subject to sampling error. Guided biopsies from neoplastic areas invisible on conventional endoscopy may increase effectiveness of surveillance examination. We assessed the accuracy of endocytoscopy in correlation with histology.
We analyzed 166 biopsy sites from 16 patients (13 male, mean age 62.1 years), without visible lesions, who presented for Barrett surveillance. Endocytoscopy images were recorded from pre-marked areas in the Barrett's segment using magnification x 1125 or x 450. Biopsies were taken from the same area to allow precise comparison with histology. Image sequences of each area were individually and blindly reviewed by a pathologist and a gastroenterologist. Major outcome variables included image quality, identification of neoplastic characteristics, and accuracy of endocytoscopy.
Adenocarcinoma was histologically diagnosed in 4.2% of biopsy sites, high grade intraepithelial neoplasia (HGIN) in 16.9%, and low grade intraepithelial neoplasia (LGIN) in 12.1 %. Adequate assessment of endocytoscopy images was impossible in 49% of the pre-marked areas with magnification x 450 and in 22% with magnification x 1125. At most, 23% of images with lower magnification were interpretable to identify characteristics of neoplasia, and 41% with higher magnification. Interobserver agreement was fair at best (kappa from < 0 to 0.45). Positive and negative predictive values for HGIN or cancer were 0.29 and 0.87, respectively, for magnification x 450 and 0.44 and 0.83, respectively, for magnification x 1125.
When not supported by macroscopic evidence, endoscopic histology using endocytoscopy lacks sufficient image quality to be currently of assistance in identifying neoplastic areas.
对巴雷特食管患者进行监测既耗时又容易出现抽样误差。对传统内镜检查中不可见的肿瘤区域进行引导活检可能会提高监测检查的有效性。我们评估了内镜细胞成像术与组织学相关性的准确性。
我们分析了16例（13例男性，平均年龄62.1岁）因巴雷特食管监测前来就诊且无可见病变患者的166个活检部位。使用1125倍或450倍放大倍数从巴雷特段预先标记的区域记录内镜细胞成像术图像。从同一区域进行活检，以便与组织学进行精确比较。病理学家和胃肠病学家分别对每个区域的图像序列进行独立盲法评估。主要结局变量包括图像质量、肿瘤特征的识别以及内镜细胞成像术的准确性。
在活检部位中，组织学诊断为腺癌的占4.2%，高级别上皮内瘤变（HGIN）占16.9%，低级别上皮内瘤变（LGIN）占12.1%。在49%的450倍放大倍数的预先标记区域和22%的1125倍放大倍数的预先标记区域中，无法对内镜细胞成像术图像进行充分评估。放大倍数较低时，最多23%的图像可用于识别肿瘤特征，放大倍数较高时为41%。观察者间一致性充其量为中等（kappa值从<0到0.45）。对于HGIN或癌症，450倍放大倍数时的阳性预测值和阴性预测值分别为0.29和0.87，1125倍放大倍数时分别为0.44和0.83。
在内镜检查没有宏观证据支持时，使用内镜细胞成像术进行的内镜组织学检查缺乏足够的图像质量，目前无法帮助识别肿瘤区域。
