Kato M, Kaise M, Yonezawa J, Yoshida Y, Tajiri H
Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
Endoscopy. 2007 Nov;39(11):937-41. doi: 10.1055/s-2007-966857.
Preliminary studies have suggested autofluorescence endoscopy (AFE) to be accurate in the diagnosis of gastric tumors. Our prospective blinded study systematically compared AFE with white light endoscopy (WLE) for the detection of superficial gastric neoplasia.
An enriched population included 33 patients with superficial gastric neoplasia referred for endoscopic submucosal dissection (ESD), and 18 control patients undergoing follow-up endoscopy after curative ESD. At the direction of a study coordinator, two endoscopists who were blinded to the patient's history and to each other's findings, performed WLE followed by AFE or performed AFE alone, in random order. Both endoscopists independently recorded the presence of lesions seen at AFE and WLE. All lesions identified in either test were biopsied and the pathological results were used as the gold standard.
39 gastric neoplasias were histologically confirmed and 52 non-neoplastic lesions were found to be either WLE- and/or AFE-positive. Sensitivities of WLE and AFE alone were 74 % vs. 64 % (n. s.) and specificities were 83 % vs. 40 % ( P = 0.0003), respectively. WLE followed by AFE had a sensitivity of 69 % (n. s.) and a specificity of 64 % ( P = 0.046 compared with WLE alone). Of all neoplasias finally diagnosed, 13 % (or in the case of elevated neoplasias, 23 %) were detected by AFE but not by WLE.
Although one quarter of elevated gastric neoplasias were detected only by AFE, its specificity is poor; therefore its clinical value is limited.
初步研究表明，自体荧光内镜检查（AFE）在胃肿瘤诊断中具有较高的准确性。我们的前瞻性盲法研究系统地比较了AFE与白光内镜检查（WLE）对浅表性胃肿瘤的检测效果。
研究对象包括33例因内镜下黏膜剥离术（ESD）而转诊的浅表性胃肿瘤患者，以及18例在ESD治愈后接受随访内镜检查的对照患者。在研究协调员的指导下，两名对患者病史及彼此检查结果均不知情的内镜医师，以随机顺序先进行WLE，随后进行AFE，或仅进行AFE。两位内镜医师分别独立记录AFE和WLE所见病变情况。两种检查中发现的所有病变均进行活检，病理结果作为金标准。
经组织学确诊的胃肿瘤有39例，发现52例非肿瘤性病变WLE和/或AFE呈阳性。单独使用WLE和AFE的敏感性分别为74%和64%（无统计学差异），特异性分别为83%和40%（P = 0.0003）。先进行WLE再进行AFE的敏感性为69%（无统计学差异），特异性为64%（与单独使用WLE相比，P = 0.046）。在最终确诊的所有肿瘤中，13%（隆起性肿瘤为23%）通过AFE而非WLE检测到。
虽然四分之一的隆起性胃肿瘤仅通过AFE检测到，但其特异性较差，因此临床价值有限。
