Eberl T, Jechart G, Probst A, Golczyk M, Bittinger M, Scheubel R, Arnholdt H, Knuechel R, Messmann H
Department of Medicine III, Klinikum Augsburg, Augsburg, Germany.
Endoscopy. 2007 Jun;39(6):497-501. doi: 10.1055/s-2007-966446.
An endocytoscope system (ECS) has recently been developed with the possibility of super-high magnification of gastrointestinal mucosa, thus allowing in vivo imaging of living cells. The aim of the present study was to assess the potential of ECS in the prediction of histology in both normal gastrointestinal mucosa and neoplastic lesions.
In total, 76 patients (57 men, 19 women; age range 37-86 years) with neoplastic lesions in the esophagus, stomach, or colon were enrolled into the study and underwent esophagogastroduodenoscopy or colonoscopy. After staining with 1% methylene blue, the mucosa was examined with the ECS probe (x 450 and x 1100 magnification), and video sequences were recorded on video disk. Biopsies from the examined areas were taken for histology and served as the gold standard. The endocytoscope video sequences were evaluated by two blinded pathologists. Finally the results were compared with those resulting from the evaluation of an experienced endoscopist who was aware of the macroscopic endoscopic pictures and the endocytoscope image results.
A total of 25 patients with esophageal lesions, 28 patients with colonic lesions, and 23 patients with gastric lesions were examined. The sensitivity and specificity for the evaluation of the blinded pathologists was 81% and 100%, respectively, in the esophagus, 56% and 89% in the stomach, and 79% and 90% in the colon. If an endoscopist evaluated the endocytoscopic pictures in combination with the macroscopic endoscopic images sensitivity and specificity increased significantly.
First experiences with ECS show good sensitivity rates even by blinded assessment for esophageal and colonic lesions. Sensitivity for neoplastic lesions in the stomach is lower because of gastric mucous secretion. Combining the endoscopic and cytoscopic appearance of the lesion may further enhance the diagnostic value of the method.
一种内镜系统（ECS）最近已被开发出来，它有可能对胃肠道黏膜进行超高倍放大，从而实现活细胞的体内成像。本研究的目的是评估ECS在预测正常胃肠道黏膜和肿瘤性病变组织学方面的潜力。
总共76例（57例男性，19例女性；年龄范围37 - 86岁）食管、胃或结肠有肿瘤性病变的患者被纳入本研究，并接受了食管胃十二指肠镜检查或结肠镜检查。在用1%亚甲蓝染色后，使用ECS探头（放大倍数为x 450和x 1100）对黏膜进行检查，并将视频序列记录在视频磁盘上。从检查区域取活检组织进行组织学检查，并将其作为金标准。由两名不知情的病理学家对内镜视频序列进行评估。最后将结果与一位了解宏观内镜图像和内镜图像结果的经验丰富的内镜医师的评估结果进行比较。
共检查了25例食管病变患者、28例结肠病变患者和23例胃病变患者。不知情的病理学家评估的敏感性和特异性在食管分别为81%和100%，在胃为56%和89%，在结肠为79%和90%。如果内镜医师结合宏观内镜图像评估内镜图像，敏感性和特异性会显著提高。
ECS的初步经验表明，即使是不知情评估，对食管和结肠病变也有良好的敏感性。由于胃黏液分泌，胃肿瘤性病变的敏感性较低。结合病变的内镜和细胞镜表现可能会进一步提高该方法的诊断价值。
