Panjehpour Masoud, Overholt Bergein F, Vo-Dinh Tuan, Coppola Domenico
Laser Center, Thompson Cancer Survival Center, Knoxville, TN 37916, USA.
Lasers Surg Med. 2012 Jul;44(5):390-6. doi: 10.1002/lsm.22033. Epub 2012 Apr 25.
Differential Normalized Fluorescence (DNF) technique has been used to distinguish high-grade dysplasia from non-dysplastic Barrett's esophagus. This technology may assist gastroenterologists in targeting biopsies, reducing the number of biopsies using the standard protocol. In the presence of reactive atypia/inflammation, it becomes difficult for the pathologist to differentiate non-dysplastic Barrett's esophagus from Barrett's esophagus with low-grade dysplasia. Before DNF technique may be used to guide target biopsies, it is critical to know whether reactive atypia/inflammation in non-dysplastic Barrett's may result in false positives. This study was conducted to determine whether DNF technique is adversely affected by the presence of reactive atypia/inflammation in non-dysplastic Barrett's esophagus resulting in false positives.
STUDY DESIGN/MATERIALS AND METHODS: Four hundred ten-nanometer laser light was used to induce autofluorescence of Barrett's mucosa in 49 patients. The clinical study included 37 males and 12 females. This was a blinded retrospective data analysis study. A total of 303 spectra were collected and matched to non-dysplastic Barrett's biopsy results. One hundred seventy-five spectra were collected from areas with a pathology of non-dysplastic Barrett's esophagus with reactive atypia/inflammation. One hundred twenty-eight spectra were collected from areas with non-dysplastic Barrett's esophagus without reactive changes/inflammation. The spectra were analyzed using the DNF Index at 480 nm and classified as positive or negative using the threshold of -0.75 × 10(-3).
Using DNF technique, 92.6% of non-dysplastic samples with reactive atypia/inflammation were classified correctly (162/175). 92.2% of non-dysplastic samples without reactive atypia/inflammation were classified correctly (118/128). Comparing the ratios of false positives among the two sample groups, there was not a statistically significant difference between the two groups.
Using DNF technique for classification of non-dysplastic Barrett's mucosa does not result in false-positive readings due to reactive atypia/inflammation. Target biopsies guided by DNF technique may drastically reduce the number of pinch biopsies using the standard biopsy protocol.
差异归一化荧光（DNF）技术已被用于区分高级别异型增生与非异型增生的巴雷特食管。这项技术可帮助胃肠病学家靶向活检，减少使用标准方案进行活检的次数。在存在反应性异型增生/炎症的情况下，病理学家很难区分非异型增生的巴雷特食管与低级别异型增生的巴雷特食管。在DNF技术可用于指导靶向活检之前，了解非异型增生的巴雷特食管中的反应性异型增生/炎症是否会导致假阳性至关重要。本研究旨在确定非异型增生的巴雷特食管中反应性异型增生/炎症的存在是否会对DNF技术产生不利影响，导致假阳性。
研究设计/材料与方法：使用410纳米激光诱导49例患者巴雷特黏膜的自发荧光。临床研究包括37名男性和12名女性。这是一项盲法回顾性数据分析研究。共收集了303个光谱，并与非异型增生的巴雷特活检结果进行匹配。从有反应性异型增生/炎症的非异型增生巴雷特食管病理区域收集了175个光谱。从无反应性改变/炎症的非异型增生巴雷特食管区域收集了128个光谱。使用480纳米处的DNF指数对光谱进行分析，并使用-0.75×10⁻³的阈值将其分类为阳性或阴性。
使用DNF技术，92.6%有反应性异型增生/炎症的非异型增生样本被正确分类（162/175）。92.2%无反应性异型增生/炎症的非异型增生样本被正确分类（118/128）。比较两个样本组之间的假阳性率，两组之间没有统计学上的显著差异。
使用DNF技术对非异型增生的巴雷特黏膜进行分类不会因反应性异型增生/炎症而导致假阳性读数。由DNF技术指导的靶向活检可能会大幅减少使用标准活检方案进行的钳取活检次数。
