共聚焦激光显微内镜对早期食管鳞癌和癌前病变的诊断价值

Clinical value of confocal laser endomicroscopy in diagnosis of early esophageal squamous cell carcinoma and precancerous lesions

目的评价共聚焦激光显微内镜对早期食管鳞癌及癌前病变的诊断价值。方法对2008年7月至2009年4月41例有食管病变、并需进一步确诊的患者，应用共聚焦激光显微内镜进行检查，根据食管鳞状细胞低级别上皮内瘤变、高级别上皮内瘤变和鳞癌的特征对病灶作出诊断，并在相应部位取活检。将共聚焦激光显微内镜的诊断结果与组织病理学结果进行比较。结果41例患者的60个病变部位经扫描得到7281张共聚焦图像。共聚焦激光显微内镜对食管低级别上皮内瘤变诊断的敏感度、特异度和准确率分别为75．0％、88．6％和85．0％。对食管高级别上皮内瘤变和早期鳞癌诊断的敏感度、特异度和准确率分别为85．7％、92．3％、90．0％和88．9％、96．1％、95．0％。结论共聚焦激光显微内镜能有效诊断食管肿瘤性病变，尤其是对高级别上皮内瘤变和早期鳞癌的诊断具有很高的准确率。

Objective To assess the value of confocal laser endomicroscopy （CLE） in diagnosis of early esophageal squamous cell carcinoma and precancerous lesions. Methods CLE examination was performed in 41 patients who needed further examination because of lesions in esophagus during July 2008 to April 2009. The diagnosis was made based on the features of esophageal squamous cells which was defined as low grade intraepithelial neoplasia（LGIN）, high grade intraepithelial neoplasia （HGIN） and early esophageal squamous cell carcinoma （EC）. Biopsy specimens were taken precisely matched to the CLE imaging sites. The result was compared with that of histopathology. Results There were 7281 confoeal images obtained from 60 target lesions in 41 patients. The sensitivity, specificity and accuracy of CLE were 75.0%, 88.6% and 85.0% in diagnosis of LGIN, respectively, 85.7%,92.3% and 90.0% in diagnosis of HGIN, respectively,and 88.9%, 96. 1% and 95.0%, in diagnosis of EC, respectively. Conclusions It is an effective method for diagnosis of esophageal neoplastic lesions using CLE, which has high accuracy in diagnosis of HGIN and early esophageal cancer.