Swager Anne-Fré, Tearney Guillermo J, Leggett Cadman L, van Oijen Martijn G H, Meijer Sybren L, Weusten Bas L, Curvers Wouter L, Bergman Jacques J G H M
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
Department of Pathology and Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Gastrointest Endosc. 2017 May;85(5):918-926.e7. doi: 10.1016/j.gie.2016.09.012. Epub 2016 Sep 19.
Volumetric laser endomicroscopy (VLE) provides a circumferential scan that enables visualization of the subsurface layers of the esophageal wall at 7 μm resolution. The aims of this study were to identify VLE features of Barrett's esophagus (BE) neoplasia and to develop a VLE prediction score.
A database of VLE images from endoscopic resection specimens, precisely correlated with histology, from patients with BE with and without neoplasia was used. Features potentially predictive for early BE neoplasia were identified by unblinded evaluation of 25 VLE-histology images. In a learning phase, 20 VLE images with or without BE neoplasia were scored by 2 VLE experts, blinded to histology. A prediction score was created by using multivariable logistic regression analyses and validated by scoring 40 VLE images (50% neoplastic) by using area under receiver operating characteristic (ROC) curve (AUC) analysis.
Three VLE features independently predictive for BE neoplasia were identified: (1) lack of layering; (2) higher surface than subsurface signal; (3) presence of irregular, dilated glands/ducts. A VLE neoplasia prediction score was developed with the following: (1) 6 points; (2) 6 or 8 points for equal or higher surface signal; and (3) 5 points. The ROC curve of this prediction score showed an AUC of 0.81 (95% confidence interval, 0.71-0.90). A cut-off value of ≥8 was associated with sensitivity and specificity of 83% and 71%, respectively.
When high-quality ex vivo VLE-histology correlation was used, the VLE features of layering, surface signal, and irregular glands/ducts were independently and significantly associated with BE neoplasia. A VLE prediction score for BE neoplasia was developed and validated, with promising accuracy. (Clinical trial registration number: NCT01862666.).
容积激光内镜显微镜检查（VLE）可提供圆周扫描，能以7微米的分辨率观察食管壁的亚表层。本研究的目的是识别巴雷特食管（BE）肿瘤形成的VLE特征，并制定一个VLE预测评分。
使用一个来自内镜切除标本的VLE图像数据库，这些图像与有或无肿瘤形成的BE患者的组织学精确相关。通过对25张VLE-组织学图像进行非盲评估，确定了可能预测早期BE肿瘤形成的特征。在学习阶段，由2名VLE专家对20张有或无BE肿瘤形成的VLE图像进行评分，专家对组织学情况不知情。通过多变量逻辑回归分析创建预测评分，并通过使用受试者操作特征曲线（ROC）下面积（AUC）分析对40张VLE图像（50%为肿瘤性）进行评分来验证。
确定了三个独立预测BE肿瘤形成的VLE特征：（1）缺乏分层；（2）表面信号高于亚表面信号；（3）存在不规则、扩张的腺体/导管。制定了一个VLE肿瘤形成预测评分，如下：（1）6分；（2）表面信号相等或更高为6或8分；（3）5分。该预测评分的ROC曲线显示AUC为0.81（95%置信区间，0.71-0.90）。截断值≥8分别与83%的敏感性和71%的特异性相关。
当使用高质量的离体VLE-组织学相关性时，分层、表面信号和不规则腺体/导管的VLE特征与BE肿瘤形成独立且显著相关。制定并验证了一个BE肿瘤形成的VLE预测评分，准确性令人满意。（临床试验注册号：NCT01862666。）
