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采用基于探针的共聚焦激光显微内镜对大肠肿瘤性息肉行实时与盲目离线诊断的准确性:一项试验性研究

发布日期:2014-1-29 12:40:31 文章来源:Endoscopy 作者次数:1174
    采用基于探针的共聚焦激光显微内镜大肠肿瘤性息肉行实时与盲目离线诊断的准确性:一项试验性研究

    M. W. Shahid1, A. M. Buchner2, M. Raimondo1, T. A. Woodward1, M. Krishna3, M. B. Wallace1

    1美国佛罗里达州杰克逊维尔市梅奥诊所胃肠病与肝病科

    2美国宾夕法尼亚州费城宾夕法尼亚大学胃肠病科

    3美国佛罗里达州杰克逊维尔市梅奥诊所病理科

    背景与研究目的:基于探针的共聚焦激光显微内镜检查(pCLE)是一种新型成像方式,它使得在内镜检查过程中行胃肠道黏膜病理组织学检查成为可能。多数研究已对pCLE图像的离线判读进行了评估。在临床实践中,实时判读是必要的,它有助于手术期间医生做出决策。本试验性研究的目的是比较手术期间所实施的实时pCLE诊断与盲目离线判读的准确性,以提供有助于规划今后研究的准确性估计值。

    患者和方法:对接受筛查与监测性结肠镜检查的患者行pCLE。一旦识别出息肉,就由一位内镜师在手术过程中分析pCLE图像并实施临时实时诊断。对所保存的视屏记录进行去识别,随机化,并于1个月后由同一内镜师审查,这位内镜师对原始诊断情况并不知情。

    结果:共记录154个息肉图像(80例肿瘤,74例非肿瘤)。对所有的154例息肉来说,实时pCLE诊断与离线pCLE诊断的总体准确性是相似的,二者的准确度分别为79%83%,灵敏度分别为81%88%,特异性分别为76%77%。其中,对<10mm的息肉来说,实时判读的准确性(准确度为78%,灵敏度为71%,特异性为83%)显著低于离线pCLE判读(同样分别为81%86%78%)。相反,对于10mm的息肉,实时pCLE诊断的准确性优于离线pCLE诊断,二者的准确度分别为85%81%,灵敏度分别为90%97%,特异性分别为75 %50%

    结论:这些结果表明,pCLE图像的实时与离线判读均比较准确。实时判读的准确性比离线诊断略小,但是这二者的总体准确性是相当的。此外,对尺寸较小与较大的息肉,诊断方法的准确性差异较大。

     

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    Accuracy of real-time vs. blinded offline diagnosis of neoplastic colorectal polyps using probe-based confocal laser endomicroscopy: a pilot study

    M. W. Shahid1, A. M. Buchner2, M. Raimondo1, T. A. Woodward1, M. Krishna3, M. B. Wallace1

    1Division of Gastroenterology and Hepatology, Mayo Clinic in Florida,Jacksonville,Florida,USA

    2Division of Gastroenterology,UniversityofPennsylvania,Philadelphia,Pennsylvania,USA

    3Division of Pathology, Mayo Clinic inFlorida,Jacksonville,Florida,USA

    Background and study aims: Probe-based confocal laser endomicroscopy (pCLE) is a new imaging modality that enables histological examination of gastrointestinal mucosa during endoscopic procedures. Most studies have evaluated offline interpretation of pCLE images. In clinical practice, real-time interpretation is necessary to assist decision-making during the procedure. The aim of this pilot study was to compare the accuracy of real-time pCLE diagnosis made during the procedure with that of blinded offline interpretation to provide accuracy estimates that will aid the planning of future studies.

    Patients and methods: pCLE was performed in patients undergoing screening and surveillance colonoscopy. Once a polyp had been identified, one endoscopist analyzed pCLE images during the procedure and made a provisional “real-time” diagnosis. Saved video recordings were de-identified, randomized, and reviewed “offline” 1 month later by the same endoscopist, who was blinded to the original diagnoses.   

    Results: Images from a total of 154 polyps were recorded (80 neoplastic, 74 non-neoplastic). The overall accuracy of real-time pCLE diagnosis (accuracy 79 %, sensitivity 81 %, specificity 76 %) and offline pCLE diagnosis (83 %, 88 %, and 77 %, respectively) for all 154 polyps were similar. Among polyps < 10 mmin size, the accuracy of real-time interpretation was significantly lower (accuracy 78 %, sensitivity 71 %, specificity 83 %) than that of offline pCLE interpretation (81 %, 86 %, 78 %, respectively). For polyps ≥ 10 mm, the accuracy of pCLE diagnosis in real-time was better (accuracy 85 %, sensitivity 90 %, specificity 75 %) than offline pCLE diagnosis (81 %, 97 %, and 50 %, respectively).

    Conclusions: These results suggest that real-time and offline interpretations of pCLE images are moderately accurate. Real-time interpretation is slightly less accurate than offline diagnosis, but overall both are comparable. Additionally, there was contrasting accuracy between the two methods for small and large polyps.

     

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