Robles Lourdes Y, Singh Satish, Fisichella Piero Marco
Department of Surgery, University of California Irvine.
Division of Gastroenterology, Boston VA Healthcare System, Boston University, Boston, Massachusetts.
J Surg Res. 2015 May 15;195(2):502-14. doi: 10.1016/j.jss.2015.02.045. Epub 2015 Feb 21.
Despite advances in diagnoses and therapy, esophageal adenocarcinoma remains a highly lethal neoplasm. Hence, a great interest has been placed in detecting early lesions and in the detection of Barrett esophagus (BE). Advanced imaging technologies of the esophagus have then been developed with the aim of improving biopsy sensitivity and detection of preplastic and neoplastic cells. The purpose of this article was to review emerging imaging technologies for esophageal pathology, spectroscopy, confocal laser endomicroscopy (CLE), and optical coherence tomography (OCT).
We conducted a PubMed search using the search string "esophagus or esophageal or oesophageal or oesophagus" and "Barrett or esophageal neoplasm" and "spectroscopy or optical spectroscopy" and "confocal laser endomicroscopy" and "confocal microscopy" and "optical coherence tomography." The first and senior author separately reviewed all articles. Our search identified: 19 in vivo studies with spectroscopy that accounted for 1021 patients and 4 ex vivo studies; 14 clinical CLE in vivo studies that accounted for 941 patients and 1 ex vivo study with 13 patients; and 17 clinical OCT in vivo studies that accounted for 773 patients and 2 ex vivo studies.
Human studies using spectroscopy had a very high sensitivity and specificity for the detection of BE. CLE showed a high interobserver agreement in diagnosing esophageal pathology and an accuracy of predicting neoplasia. We also found several clinical studies that reported excellent diagnostic sensitivity and specificity for the detection of BE using OCT.
Advanced imaging technology for the detection of esophageal lesions is a promising field that aims to improve the detection of early esophageal lesions. Although advancing imaging techniques improve diagnostic sensitivities and specificities, their integration into diagnostic protocols has yet to be perfected.
尽管在诊断和治疗方面取得了进展，但食管腺癌仍然是一种高度致命的肿瘤。因此，人们对早期病变的检测以及巴雷特食管（BE）的检测产生了浓厚兴趣。随后开发了先进的食管成像技术，旨在提高活检敏感性以及对癌前和肿瘤细胞的检测能力。本文的目的是综述用于食管病理学的新兴成像技术、光谱学、共聚焦激光内镜显微镜检查（CLE）和光学相干断层扫描（OCT）。
我们在PubMed上进行了搜索，搜索词为“食管或食道”以及“巴雷特或食管肿瘤”以及“光谱学或光学光谱学”以及“共聚焦激光内镜显微镜检查”以及“共聚焦显微镜检查”以及“光学相干断层扫描”。第一作者和资深作者分别审阅了所有文章。我们的搜索发现：19项光谱学的体内研究，涉及1021名患者以及4项体外研究；14项CLE的临床体内研究，涉及941名患者以及1项有13名患者的体外研究；以及17项OCT的临床体内研究，涉及773名患者以及2项体外研究。
使用光谱学的人体研究对BE的检测具有非常高的敏感性和特异性。CLE在诊断食管病理学方面显示出较高的观察者间一致性以及预测肿瘤形成的准确性。我们还发现了几项临床研究，报告了使用OCT检测BE具有出色的诊断敏感性和特异性。
用于检测食管病变的先进成像技术是一个有前景令人期待的领域，旨在提高早期食管病变的检测能力。尽管先进的成像技术提高了诊断敏感性和特异性，但它们在诊断方案中的整合仍有待完善。
