Department of Medicine II, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, Munich, Germany.
Endoscopy. 2011 May;43(5):419-24. doi: 10.1055/s-0030-1256215. Epub 2011 Feb 28.
Autofluorescence imaging (AFI) is sensitive but not specific for differentiating neoplastic from non-neoplastic colorectal polyps. We aimed to determine the sensitivity and specificity of fluorescein-enhanced AFI (FAFI) in differentiating neoplastic from non-neoplastic colorectal polyps.
All patients with colorectal polyps detected during AFI colonoscopy received intravenous fluorescein followed by AFI (FAFI). The video sequences were recorded and divided into a learning group and a test group. AFI and FAFI criteria for neoplastic and non-neoplastic lesions were determined after viewing videos in the learning group unblinded to histology. Videos in the test group were viewed blinded to histology, and diagnoses of neoplastic versus non-neoplastic were made for AFI and FAFI using the predetermined criteria. Still frames were objectively measured for red:green ratio (AFI) and green contrast (FAFI).
Eight videos (four neoplastic, four non-neoplastic) were used for the learning group. Criteria for neoplasia when using FAFI were determined as the presence of a patchy or granular pattern which appeared more fluorescent green compared with the background. For AFI, purple or pink represented neoplasia; green represented non-neoplasia. In the test group (13 neoplastic, 12 non-neoplastic), for differentiating between neoplasia and non-neoplasia, subjective analysis of video sequences yielded a sensitivity of 100 % for AFI and 100 % for FAFI ( P = 1.000), and a specificity of 16.7 % for AFI and 91.7 % for FAFI ( P = 0.004). Using objective color analysis, the area under the receiver operating characteristics curve was 0.647 for AFI using the red:green ratio to distinguish between neoplasia and non-neoplasia, and 0.994 for FAFI using green contrast.
FAFI accurately differentiated between neoplastic and non-neoplastic colorectal polyps.
自发荧光成像（AFI）对鉴别肿瘤性和非肿瘤性结直肠息肉敏感，但特异性不高。本研究旨在确定荧光素增强自发荧光成像（FAFI）在鉴别肿瘤性和非肿瘤性结直肠息肉中的敏感性和特异性。
所有在 AFI 结肠镜检查中发现的结直肠息肉患者均接受静脉注射荧光素后行 AFI（FAFI）。记录视频序列，并将其分为学习组和测试组。在观看学习组的视频时，不参照组织学结果来确定用于诊断肿瘤性和非肿瘤性病变的 AFI 和 FAFI 标准。然后，在不参照组织学结果的情况下，观看测试组的视频，并使用预定的标准，根据 AFI 和 FAFI 结果对病变进行肿瘤性与非肿瘤性的诊断。使用客观的红：绿比（AFI）和绿对比度（FAFI）对静止帧进行测量。
学习组使用了 8 个视频（4 个肿瘤性，4 个非肿瘤性）。使用 FAFI 诊断肿瘤性病变的标准为存在斑片状或颗粒状模式，与背景相比，其荧光绿色更明显。对于 AFI，紫色或粉红色代表肿瘤性病变；绿色代表非肿瘤性病变。在测试组（13 个肿瘤性，12 个非肿瘤性）中，用于区分肿瘤性和非肿瘤性病变，视频序列的主观分析显示，AFI 的敏感性为 100%，FAFI 的敏感性为 100%（P=1.000），AFI 的特异性为 16.7%，FAFI 的特异性为 91.7%（P=0.004）。使用客观的颜色分析，使用红：绿比区分肿瘤性和非肿瘤性病变时，AFI 的受试者工作特征曲线下面积为 0.647，使用绿对比度区分时，FAFI 的曲线下面积为 0.994。
FAFI 可准确区分肿瘤性和非肿瘤性结直肠息肉。
