Smith Lesley-Ann, Tiffin Nick, Thomson Mike, Cross Simon S, Hurlstone David P
The General Infirmary, Leeds, Yorkshire, UK.
J Gastroenterol Hepatol. 2008 Jul;23(7 Pt 1):1009-23. doi: 10.1111/j.1440-1746.2008.05463.x. Epub 2008 Jun 28.
Advances in imaging technology and engineering have now permitted functional integration of a confocal endomicroscope into the distal tip of a conventional video colonoscope enabling imaging of the surface epithelium and the underlying lamina propria during ongoing video endoscopy. For the first time, the endoscopist is now able to resolve the surface and subsurface mucosa at cellular resolution in vivo and in real time. A new era in endoscopic imaging has therefore begun - histoendoscopy. In addition to providing a high-accuracy in vivo optical biopsy tool for the differentiation between benign hyperplasia, intra-epithelial neoplasia and carcinoma in sporadic cohorts, endomicroscopy with targeted biopsies has now been shown to increase the yield of intra-epithelial neoplasia complicating ulcerative colitis. Furthermore, recent data examining endomicroscopic molecular ex vivo imaging using anti-CD44v6 antibody has identified aberrant crypt foci based on their surface molecular expression. Receptor overexpression in vivo in humans may, in the near future, be exploited for the diagnosis of inflammation, neoplasia and in predicting targeted molecular therapy. Endomicroscopy will be key to this immuno-imaging interface. Within the present review, we discuss the current clinical evidence in support of confocal endomicroscopy and explore the new diagnostic possibilities for this technology.
成像技术和工程学的进步现已使共聚焦内镜显微镜功能整合到传统视频结肠镜的远端，从而能够在进行视频内镜检查时对表面上皮和下方的固有层进行成像。内镜医师首次能够在体内实时以细胞分辨率分辨表面和亚表面黏膜。因此，内镜成像的新时代——组织内镜检查已经开启。除了为散发性人群中良性增生、上皮内瘤变和癌的鉴别提供高精度的体内光学活检工具外，靶向活检的内镜显微镜检查现已证明可提高溃疡性结肠炎并发上皮内瘤变的检出率。此外，最近使用抗CD44v6抗体进行内镜显微镜分子体外成像的数据已根据异常隐窝灶的表面分子表达识别出它们。在不久的将来，人体内受体的过表达可能会被用于炎症、肿瘤的诊断以及预测靶向分子治疗。内镜显微镜检查将是这种免疫成像界面的关键。在本综述中，我们讨论了支持共聚焦内镜显微镜检查的当前临床证据，并探索了该技术的新诊断可能性。
