容积激光内镜显微镜与共聚焦激光内镜显微镜在检测巴雷特食管相关异型增生中的诊断性能比较
Comparative diagnostic performance of volumetric laser endomicroscopy and confocal laser endomicroscopy in the detection of dysplasia associated with Barrett's esophagus.
作者信息
Leggett Cadman L, Gorospe Emmanuel C, Chan Daniel K, Muppa Prasuna, Owens Victoria, Smyrk Thomas C, Anderson Marlys, Lutzke Lori S, Tearney Guillermo, Wang Kenneth K
机构信息
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Division of Gastroenterology and Liver Pathology, Mayo Clinic, Rochester, Minnesota, USA.
出版信息
Gastrointest Endosc. 2016 May;83(5):880-888.e2. doi: 10.1016/j.gie.2015.08.050. Epub 2015 Sep 3.
BACKGROUND AND AIMS
Probe-based confocal laser endomicroscopy (pCLE) and volumetric laser endomicroscopy (VLE) (also known as frequency domain optical coherence tomography) are advanced endoscopic imaging modalities that may be useful in the diagnosis of dysplasia associated with Barrett's esophagus (BE). We performed pCLE examination in ex-vivo EMR specimens and compared the diagnostic performance of using the current VLE scoring index (previously established as OCT-SI) and a novel VLE diagnostic algorithm (VLE-DA) for the detection of dysplasia.
METHODS
A total of 27 patients with BE enrolled in a surveillance program at a tertiary-care center underwent 50 clinically indicated EMRs that were imaged with VLE and pCLE and classified into neoplastic (N = 34; high-grade dysplasia, intramucosal adenocarcinoma) and nonneoplastic (N = 16; low-grade dysplasia, nondysplastic BE), based on histology. Image datasets (VLE, N = 50; pCLE, N = 50) were rated by 3 gastroenterologists trained in the established diagnostic criteria for each imaging modality as well as a new diagnostic algorithm for VLE derived from a training set that demonstrated association of specific VLE features with neoplasia. Sensitivity, specificity, and diagnostic accuracy were assessed for each imaging modality and diagnostic criteria.
RESULTS
The sensitivity, specificity, and diagnostic accuracy of pCLE for detection of BE dysplasia was 76% (95% confidence interval [CI], 59-88), 79% (95% CI, 53-92), and 77% (95% CI, 72-82), respectively. The optimal diagnostic performance of OCT-SI showed a sensitivity of 70% (95% CI, 52-84), specificity of 60% (95% CI, 36-79), and diagnostic accuracy of 67%; (95% CI, 58-78). The use of the novel VLE-DA showed a sensitivity of 86% (95% CI, 69-96), specificity of 88% (95% CI, 60-99), and diagnostic accuracy of 87% (95% CI, 86-88). The diagnostic accuracy of using the new VLE-DA criteria was significantly superior to the current OCT-SI (P < .01).
CONCLUSION
The use of a new VLE-DA showed enhanced diagnostic performance for detecting BE dysplasia ex vivo compared with the current OCT-SI. Further validation of this algorithm in vivo is warranted.
背景与目的
基于探头的共聚焦激光内镜检查（pCLE）和容积激光内镜检查（VLE，也称为频域光学相干断层扫描）是先进的内镜成像方式，可能有助于诊断与巴雷特食管（BE）相关的发育异常。我们对离体的内镜黏膜下剥离术（EMR）标本进行了pCLE检查，并比较了使用当前的VLE评分指数（先前确定为OCT-SI）和一种新型VLE诊断算法（VLE-DA）检测发育异常的诊断性能。
方法
在一家三级医疗中心参加监测项目的27例BE患者接受了50次临床指征性EMR，这些标本用VLE和pCLE成像，并根据组织学分类为肿瘤性（N = 34；高级别发育异常、黏膜内腺癌）和非肿瘤性（N = 16；低级别发育异常、无发育异常的BE）。图像数据集（VLE，N = 50；pCLE，N = 50）由3名接受过每种成像方式既定诊断标准以及源自训练集的新型VLE诊断算法培训的胃肠病学家进行评分，该训练集证明了特定VLE特征与肿瘤形成的相关性。评估了每种成像方式和诊断标准的敏感性、特异性和诊断准确性。
结果
pCLE检测BE发育异常的敏感性、特异性和诊断准确性分别为76%（95%置信区间[CI]，59 - 88）、79%（95% CI，53 - 92）和77%（95% CI，72 - 82）。OCT-SI的最佳诊断性能显示敏感性为70%（95% CI，52 - 84），特异性为60%（95% CI，36 - 79），诊断准确性为67%（95% CI，58 - 78）。使用新型VLE-DA显示敏感性为86%（95% CI，69 - 96），特异性为88%（95% CI，60 - 99），诊断准确性为87%（95% CI，86 - 88）。使用新的VLE-DA标准的诊断准确性明显优于当前的OCT-SI（P <.01）。
结论
与当前的OCT-SI相比，使用新型VLE-DA在离体检测BE发育异常方面显示出更高的诊断性能。有必要在体内对该算法进行进一步验证。
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