自体荧光成像后巴雷特食管早期瘤变预测因素的识别：一项逐步多中心结构化评估

Identification of predictive factors for early neoplasia in Barrett's esophagus after autofluorescence imaging: a stepwise multicenter structured assessment.

作者信息

Curvers Wouter L, Singh Rajvinder, Wallace Michael B, Song Louis-Michel Wong Kee, Ragunath Krish, Wolfsen Herbert C, ten Kate Fiebo J, Fockens Paul, Bergman Jacques J G H M

机构信息

Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.

出版信息

Gastrointest Endosc. 2009 Jul;70(1):9-17. doi: 10.1016/j.gie.2008.10.026. Epub 2009 Apr 25.

DOI:10.1016/j.gie.2008.10.026

PMID:19394009

Abstract

BACKGROUND

Autofluorescence imaging is a novel imaging technique that may improve the detection of early neoplasia in Barrett's esophagus. Autofluorescence imaging is, however, associated with a 40% to 81% false-positive rate.

OBJECTIVE

Our purpose was to identify endoscopic features that may predict the presence of early neoplasia in autofluorescence-positive areas.

DESIGN

Descriptive and prospective cohort study.

SETTING

Tertiary referral centers for the detection and treatment of early Barrett's neoplasia.

PATIENTS AND METHODS

Patients undergoing autofluorescence endoscopy. High-quality images with autofluorescence imaging and white-light endoscopy were obtained with corresponding histologic study. A systematic image evaluation process was performed, including an unblinded orientation phase (10 areas), a blinded derivation phase, and a blinded validation phase by 5 international experts in autofluorescence imaging (80 areas). Subsequently the identified features were validated in a prospective pilot study.

MAIN OUTCOME MEASUREMENTS

Association between endoscopic features and presence of early neoplasia in autofluorescence-positive areas.

RESULTS

Autofluorescence intensity, proximity of gastric folds <1 cm, and different appearance on white-light endoscopy were independently associated with early neoplasia in autofluorescence-positive areas on multivariate analysis. The kappa values for interobserver agreement of these factors were moderate, ranging between 0.49 to 0.56. The association with autofluorescence intensity and different appearance on white-light endoscopy was confirmed in a prospective pilot study.

LIMITATION

Selected set of images from a high-risk population (tertiary referral center).

CONCLUSION

We found specific endoscopic features that were associated with early neoplasia in autofluorescence-positive areas. These findings can be used in future prospective studies to improve the accuracy of autofluorescence imaging without performing magnification endoscopy for detailed inspection of suspicious areas.

摘要