Holz Jasmin A, Boerwinkel David F, Meijer Sybren L, Visser Mike, van Leeuwen Ton G, Aalders Maurice C G, Bergman Jacques J G H M
Departments of aBiomedical Engineering and Physics bGastroenterology and Hepatology cPathology, Academic Medical Centre, Amsterdam, The Netherlands.
Eur J Gastroenterol Hepatol. 2013 Dec;25(12):1442-9. doi: 10.1097/MEG.0b013e328365f77b.
Fluorescence spectroscopy has the potential to detect early cellular changes in Barrett's oesophagus before these become visible. As the technique is based on varying concentrations of intrinsic fluorophores, each with its own optimal excitation wavelength, it is important to assess the optimal excitation wavelength(s) for identification of premalignant lesions in patients with Barrett's oesophagus.
The endoscopic spectroscopy system used contained five (ultra)violet light sources (λexc=369-416 nm) to generate autofluorescence during routine endoscopic surveillance. Autofluorescence spectroscopy was followed by a biopsy for histological assessment and spectra correlation. Three intensity ratios (r1, r2, r3) were calculated by dividing the area, A, under the spectral curve of selected emission wavelength ranges for each spectrum generated by each excitation wavelength λexc as follows (Equation is included in full-text article.). Double intensity ratios were calculated using two excitation wavelengths.
Fifty-eight tissue areas from 22 patients were used for autofluorescence spectra analysis. Excitation with 395, 405 or 410 nm showed a significant (P≤0.0006) differentiation between intestinal metaplasia and grouped high-grade dysplasia/early carcinoma for intensity ratios r2 and r3. A sensitivity of 80.0% and specificity of 89.5% with an area under the ROC curve of 0.85 was achieved using 395 nm excitation and intensity ratio r3.
Double excitation showed no additional value over single excitation. The combination of 395 nm excitation and intensity ratio r3 showed optimal conditions to discriminate nondysplastic from early neoplasia in Barrett's oesophagus.
荧光光谱法有潜力在巴雷特食管的早期细胞变化变得可见之前检测到它们。由于该技术基于不同浓度的内源性荧光团，每个荧光团都有其自身的最佳激发波长，因此评估用于识别巴雷特食管患者癌前病变的最佳激发波长非常重要。
所使用的内镜光谱系统包含五个（超）紫外光源（λexc = 369 - 416 nm），以便在常规内镜监测期间产生自体荧光。自体荧光光谱分析之后进行活检以进行组织学评估和光谱相关性分析。通过将每个激发波长λexc产生的每个光谱的选定发射波长范围内的光谱曲线下的面积A相除，计算出三个强度比（r1、r2、r3），如下所示（方程式包含在全文中）。使用两个激发波长计算双强度比。
来自22名患者的58个组织区域用于自体荧光光谱分析。对于强度比r2和r3，用395、405或410 nm激发显示肠化生与分组的高级别异型增生/早期癌之间有显著差异（P≤0.0006）。使用395 nm激发和强度比r3时，灵敏度为80.0%，特异性为89.5%，ROC曲线下面积为0.85。
双激发与单激发相比没有额外价值。395 nm激发和强度比r3的组合显示出区分巴雷特食管中无发育异常与早期肿瘤形成的最佳条件。
