自体荧光内镜对消化道肿瘤的诊断价值

Diagnostic Value of Autofluorescence Endoscopy in Gastrointestinal Neoplasms

背景：自体荧光内镜应用于临床已十余年,但其对良恶性病变的鉴别仍存在争议.目的：评估自体荧光内镜对消化道肿瘤的诊断价值.方法：对2009年6～11月于上海仁济医院接受手术治疗的110例确诊或疑诊消化道恶性肿瘤患者的手术切除标本（包括病灶组织和周围正常组织）行自体荧光内镜检查,以病理检查结果为标准分析其诊断准确性.结果：自体荧光内镜对早期癌的检出率为86.7%,对进展期癌的检出率为95.5%;其诊断消化道恶性肿瘤的总体敏感性、特异性、阳性预测值、阴性预测值和诊断准确率分别为94.2%、94.0%、93.3%、94.8%和94.1%.结论：自体荧光内镜对消化道恶性肿瘤的诊断具有高敏感性,对检出形态特征不明显的病变较普通内镜有更大优势,易于发现肉眼难以识别的可疑病灶并确定其发生部位和范围,可精确指导活检,对提高早期癌的检出率具有重要意义.

Background： Autofluoreseence endoscopy has been applied in clinical practice for more than ten years, but it is still disputed for its value in the differentiation of malignant from benign lesions. Aims： To assess the diagnostic value of autofluorescence endoscopy in gastrointestinal neoplasms. Methods： Resected specimens of 110 patients with definite or suspicious gastrointestinal malignancies undergone surgical intervention from June 2009 to November 2009 in Shanghai Renji Hospital were collected. Autofluorescence endoscopy was used to detect the autofluorescence imaging in neoplastic and adjacent normal tissues in vitro. The accuracy was analyzed according to the results of pathological examination. Results： The detection rate of autofluorescence endoscopy for early cancer was 86.7%, and for advanced cancer was 95.5%. Its overall sensitivity, specificity, positive predictive value and negative predictive value were 94.2%, 94.0%, 93.3% and 94.8%, respectively. The diagnostic accuracy was 94.1%. Conclusions： Autofluorescence endoscopy is sensitive for the detection of gastrointestinal malignancies. It is advantageous over conventional endoscopy in detecting atypical lesions and suspicious lesions, in determining the site and extent of cancerous lesions, and in guiding biopsy more precisely. Autofluorescence endoscopy may become a potential tool for the early detection of gastrointestinal malignancies.