自体荧光内镜诊断消化道恶性肿瘤和癌前病变的临床初探

Autofluorescence Endoscopy for Diagnosis of Gastrointestinal Malignant and Precancerous Lesions: A Pilot Study

背景：自体荧光内镜应用于临床已十余年，但对其诊断消化道恶性肿瘤和癌前病变的价值仍存在争议。目的：探讨自体荧光内镜在消化道恶性肿瘤和癌前病变中的诊断价值。方法：对2010年6月～2013年3月于上海交通大学医学院附属仁济医院确诊或高度怀疑消化道恶性肿瘤以及随访癌前病变患者的170例离体手术标本和30例在体受试者进行自体荧光内镜检查，以组织病理学检查结果作为金标准。结果：自体荧光内镜诊断消化道恶性肿瘤和癌前病变的总体准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为94．0％、94．6％、93．5％、92．6％和95．3％。自体荧光内镜与组织病理学诊断结果一致性较高（κ=0．880）。离体试验中，癌前病变和早期癌与进展期癌的检出率无显著差异（88．2％对95．8％，P=0．238），分化型癌与未分化型癌的检出率差异显著（97．9％对86．8％，P=0．009）；在体试验中，分化型癌与未分化型癌的检出率无显著差异（94．1％对80．0％，P=0．373）。结论：自体荧光内镜对于消化道恶性肿瘤和癌前病变具有较高的诊断价值，有望成为诊断早期消化道恶性肿瘤的重要手段。

Background：Autofluorescence endoscopy has been applied for diagnosing gastrointestinal malignant and precancerous lesions for more than ten years, however, it＇s＇diagnostic value is still controversial. Aims： To investigate the diagnostic value of autofluorescence endoscopy in gastrointestinal malignant and precancerous lesions. Methods： A total of 170 operation specimens in vitro and 30 patients in vivo with definite or highly suspicious gastrointestinal malignancies or followed up for precancerous lesions were enrolled from June 2010 to March 2013 in Renji Hospital, Shanghai Jiaotong University School of Medicine. Autofluorescence endoscopy was used to detect the autofluorescence imaging. Histopathology was considered as golden standard. Results： The overall accuracy, sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of autofluorescence endoscopy in diagnosing gastrointestinal malignant and precancerous lesions were 94. 0% , 94. 6% , 93. 5% , 92. 6% and 95. 3% , respectively. The agreement between autofluorescence endoscopy and histopathological examination was excellent （ κ = 0.880）. In vitro, no significant difference in detection rate was found between precancerous lesion/early cancer and advanced cancer （88.2% vs. 95.8% , P = 0. 238）, however, significant difference in detection rate was found between differentiated cancer and undifferentiated cancer （ 97.9% vs. 86. 8% , P = 0. 009 ）. In vivo, no significant difference in detection rate was found between differentiated cancer and undifferentiated cancer （94. 1% vs. 80.0%, P = 0. 373）. Conclusions： Autofluorescence endoscopy can be used to diagnose gastrointestinal malignant and precancerous lesions with high diagnostic value. It may become a promising diagnostic modality for the early detection of gastrointestinal malignancies.