Hurlstone D P, Baraza W, Brown S, Thomson M, Tiffin N, Cross S S
Gastroenterology and Liver Unit, Royal Hallamshire Hospital, University of Sheffield Medical School, Sheffield, UK.
Br J Surg. 2008 May;95(5):636-45. doi: 10.1002/bjs.5988.
Conventional colonoscopy has a significant false-negative rate for intraepithelial neoplasia. Chromoendoscopy increases sensitivity but lacks specificity. The aim was to assess prospectively the clinical applicability and predictive power of the EC3870CIFK confocal laser endomicroscope (CLE) for the in vivo diagnosis of intraepithelial neoplasia during colonoscopy.
Lesions were identified using chromoscopy followed by CLE imaging and graded according to vascular and cellular changes. CLE imaging of circumscribed lesions and four segmental 'normal' colorectal quadrants was performed. Targeted biopsy specimens were then compared with histopathological results.
Forty patients completed the protocol (22 men and 18 women; median age 62 (range 39-82) years). The median duration of ileal intubation and total procedure time were 12 (range 5-26) and 55 (range 28-92) min respectively. Chromoscopic colonoscopy revealed 162 lesions in 39 patients. CLE imaging was obtained on all 162 lesions. Some 5422 confocal images were compared with 802 targeted biopsy specimens. Intraepithelial neoplasia was predicted with an accuracy of 99.1 per cent (sensitivity 97.4 per cent and specificity 99.3 per cent) (P = 0.711).
Confocal laser endomicroscopy permits high-quality cellular, subsurface vascular and stromal imaging, enabling prediction of intraepithelial neoplasia with a high level of accuracy.
传统结肠镜检查对上皮内瘤变的假阴性率较高。色素内镜检查可提高敏感性，但缺乏特异性。本研究旨在前瞻性评估EC3870CIFK共聚焦激光内镜显微镜（CLE）在结肠镜检查中对上皮内瘤变进行活体诊断的临床适用性和预测能力。
采用色素内镜检查识别病变，随后进行CLE成像，并根据血管和细胞变化进行分级。对局限性病变和四个节段性“正常”结直肠象限进行CLE成像。然后将靶向活检标本与组织病理学结果进行比较。
40例患者完成了研究方案（22例男性和18例女性；中位年龄62岁（范围39 - 82岁））。回肠插管的中位持续时间和总操作时间分别为12分钟（范围5 - 26分钟）和55分钟（范围28 - 92分钟）。色素内镜结肠镜检查在39例患者中发现了162个病变。所有162个病变均获得了CLE成像。共比较了约5422张共聚焦图像和802个靶向活检标本。上皮内瘤变的预测准确率为99.1%（敏感性97.4%，特异性99.3%）（P = 0.711）。
共聚焦激光内镜检查可实现高质量的细胞、黏膜下血管和基质成像，能够高精度地预测上皮内瘤变。
