Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
Dis Esophagus. 2014 Apr;27(3):276-84. doi: 10.1111/dote.12094. Epub 2013 Jun 24.
In Barrett's esophagus (BE), second-generation autofluorescence imaging (AFI-II) improves targeted detection of high-grade intra-epithelial neoplasia (HGIN) and early cancer (EC), yet suffers from high false-positive (FP) rates. The newest generation AFI (AFI-III) specifically targets fluorescence in malignant cells and may therefore improve detection of early neoplasia and reduce FP rate. The aim was to compare AFI-III with AFI-II for endoscopic detection of early neoplasia in BE. BE patients with endoscopically inconspicuous neoplasia underwent two diagnostic endoscopies (AFI-II/AFI-III) in a single session. End-points: number of patients and lesions with HGIN/EC detected with AFI-II and AFI-III after white-light endoscopy (WLE) and the value of reinspection of AFI-positive areas with WLE and narrow-band imaging. Forty-five patients were included (38 males, age 65 years). Nineteen patients showed HGIN/EC. AFI-II inspection after WLE increased detection of HGIN/EC from 9 to 15 patients (47 to 79%); AFI-III increased detection from 9 to 17 patients (47 to 89%). WLE plus random biopsies diagnosed 13/19 (68%) HGIN/EC patients. One hundred and four abnormal AFI areas were inspected; 23 (22%) showed HGIN/EC. AFI-II increased detection of HGIN/EC from 10 to 18 lesions (43 to 78%). AFI-III increased detection from 10 to 20 lesions (43-87%). FP rate was 86% for AFI-II and AFI-III. Reinspection with WLE or narrow-band imaging reduced FP rate to 21% and 22%, respectively, but misclassified HGIN/EC lesions as unsuspicious in 54% and 31%, respectively. This first feasibility study on third-generation AFI again showed improved targeted detection of HGIN/EC in BE. However, the results do not suggest AFI-III performs significantly better than conventional AFI-II.
在 Barrett 食管（BE）中，第二代自发荧光成像（AFI-II）可提高高级上皮内瘤变（HGIN）和早期癌症（EC）的靶向检测能力，但假阳性（FP）率较高。最新一代 AFI（AFI-III）专门针对恶性细胞中的荧光，因此可能提高早期肿瘤的检测能力并降低 FP 率。目的是比较 AFI-III 与 AFI-II 在内镜下检测 BE 早期肿瘤的效果。对内镜下无明显肿瘤的 BE 患者在单次检查中进行两次诊断性内镜检查（AFI-II/AFI-III）。终点：白光内镜（WLE）后，用 AFI-II 和 AFI-III 检测到 HGIN/EC 的患者和病变数量，以及 WLE 和窄带成像对 AFI 阳性区域进行再检查的价值。共纳入 45 例患者（38 例男性，年龄 65 岁）。19 例患者显示 HGIN/EC。WLE 后 AFI-II 检查使 HGIN/EC 的检出率从 9 例增加到 15 例（47%到 79%）；AFI-III 使检出率从 9 例增加到 17 例（47%到 89%）。WLE 加随机活检诊断出 19 例 HGIN/EC 患者中的 13 例（68%）。共检查了 104 个异常 AFI 区域，其中 23 个（22%）显示 HGIN/EC。AFI-II 使 HGIN/EC 的检出率从 10 个病变增加到 18 个病变（43%到 78%）；AFI-III 使检出率从 10 个病变增加到 20 个病变（43%到 87%）。AFI-II 和 AFI-III 的 FP 率分别为 86%和 86%。用 WLE 或窄带成像进行再检查将 FP 率分别降低至 21%和 22%，但将 54%和 31%的 HGIN/EC 病变错误分类为无异常。这项第三代 AFI 的首次可行性研究再次表明，第三代 AFI 可改善 Barrett 食管中 HGIN/EC 的靶向检测。然而，结果并未表明 AFI-III 的表现明显优于传统的 AFI-II。
