自体荧光联合窄带成像技术对Barrett食管上皮内瘤变的诊断价值

Auto fluorescence imaging combined with narrow band imaging technology research for the diagnosis of early neoplasia in Barrett's esophagus

目的评价自体荧光(AFI)联合窄带成像(NBI)技术对Barrett食管上皮内瘤变的诊断价值。方法对50例患者自体荧光内镜诊断Barrett的74个可疑上皮内瘤变的病灶,进一步行窄带成像检查,观察黏膜微血管及小凹的改变,并于相应病变区取活检送病理检查。结果在AFI诊断74例可疑病灶中共有44例病灶病理确诊为高级别上皮内瘤变(HGIN),30例病灶为假阳性。NBI对这44例病灶HGIN的诊断:确诊39例,可疑5例;在30例HGIN假阳性的病灶中,NBI假阳性为7例。两者的假阳性率由40.5%减少至14.9%。自体荧光内镜对Barrett食管HGIN诊断的阳性预测值为59.5%(44/74),AFI联合NBI技术后诊断的阳性预测值为84.8%(39/46)。结论自体荧光联合NBI技术可提高Barrett食管高级别上皮内瘤变的检出率。

Objective To explore the diagnosis value of auto fluorescence imaging endoscopy combined with narrow band imaging technology in the identification of early neoplasia in Barrett＆#39;s esophagus. Methods 50 patients with Barrett＆#39;s esophagus with suspected were investigated with 2 prototype imaging systems：AFI（inspection with high-resolution videoendoscopy and autofluorescence imaging for detection of lesions） and NBI（for detailed inspection of mucosal and vascular patterns of identified lesions）. Lesions were sampled for histopathologic evaluation. Results All of the 74 lesions with HGIN were identified with AFI. 74 suspicious lesions were detected with AFI：44 contained HGIN and 30 were false positive. With NBI, 39 of the true-positive lesions had definitely suspicious patterns, and 5 had dubiously suspicious patterns. Of the 30 false positives, 23 were not suspicious on NBI. The false-positive rate, therefore, was reduced from 40.5%to 14.9%. The PPV of AFI to the diagnosis of HGIN in BE was 59.5%（44/74） and that of AFI-NBI was 84.8%（39/46）. Conclusion AFI combined with NBI endoscopy can enhance the detection rate of early neoplasia in Barrett＆#39;s esophagus.