Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital AG, Aarau, Switzerland.
Head Neck. 2011 Jul;33(7):941-8. doi: 10.1002/hed.21565. Epub 2010 Nov 29.
Fluorescence endoscopy is used for the early detection and delineation of laryngeal cancer and its precursor lesions. No systematic review of these promising imaging techniques has yet been performed.
A systematic review of the published literature and meta-analysis of data extracted from 16 included studies were performed. A total of 1000 laryngeal lesions were examined by autofluorescence endoscopy (AFE), 318 mucosal changes by induced fluorescence endoscopy (IFE), and 679 laryngeal pathologies underwent normal white light endoscopy (WLE).
In identifying precancerous and cancerous lesions of the larynx, sensitivity (91% vs 73%), specificity (84% vs 79%), and accuracy (88% vs 77%) of AFE were superior to WLE alone, whereas IFE showed an even higher sensitivity (95% vs 73%) at the expense of specificity (62% vs 79%). Therefore, AFE also achieved a higher specificity (84% vs 62%) and accuracy (88% vs 76%) than did IFE in detecting these kinds of lesions. However, the sensitivity (91% vs 95%) did not differ significantly between both methods.
This meta-analysis confirms that fluorescence endoscopy is highly effective in the early diagnosis of laryngeal cancer and its precursor lesions. Thus, AFE can be used immediately without drug administration or possible side effects, whereas IFE is more suited for the detection of recurrent disease following initial surgery.
荧光内镜用于早期发现和描绘喉癌及其前体病变。目前尚未对这些有前途的成像技术进行系统评价。
对已发表的文献进行系统评价，并对 16 项纳入研究中提取的数据进行荟萃分析。共对 1000 个喉病变进行了自发荧光内镜（AFE）检查，318 个黏膜变化进行了诱导荧光内镜（IFE）检查，679 个喉病变进行了常规白光内镜（WLE）检查。
在识别喉癌前病变和癌性病变时，AFE 的敏感性（91%比 73%）、特异性（84%比 79%）和准确性（88%比 77%）优于单独的 WLE，而 IFE 的敏感性（95%比 73%）更高，但特异性（62%比 79%）较低。因此，AFE 在检测这些病变时也具有更高的特异性（84%比 62%）和准确性（88%比 76%）。然而，两种方法的敏感性（91%比 95%）没有显著差异。
这项荟萃分析证实，荧光内镜在喉癌及其前体病变的早期诊断中具有很高的效果。因此，AFE 可以立即使用，无需药物治疗或可能的副作用，而 IFE 更适合检测初始手术后的复发性疾病。
