自身荧光内镜在早期喉癌及其癌前病变诊断中的应用

目的研究用自身荧光内镜在早期喉癌和癌前病变诊断中的应用价值。方法75例疑有早期喉癌及癌前病变的患者在显微喉镜下暴露喉腔，由短弧氙灯提供的过滤蓝光（波长380～460nm）激发检查部位的自身荧光，通过高清晰度摄像系统获取自身荧光图像并加以分析、诊断，图像储存并与组织病理学结果做比较。结果正常喉黏膜和轻度上皮非典型性增生显示典型的亮绿色荧光信号，中、高度上皮非典型性增生，原位癌和浸润癌呈现绿色荧光的减少、消失；自身荧光内镜可把高度非典型性增生和癌前病变与低度非典型性增生和炎性病变区别开来，敏感度可达97．8％．特异性为86．7％。假阴性结果（1例）是由重度的上皮过度角化所致；黏膜的炎症充血和瘢痕易于产生假阳性结果（4例）。结论自身荧光内镜图像技术是无创性诊断喉癌及其癌前病变的辅助性方法，操作简单，敏感度高，但存在一定的假阳性率。

Autofluorescence endoscopy for diagnosing early laryngeal cancer and its precursor lesions

Objective To assess autofluorescence endoscopy in the diagnosis of early laryngeal cancer and its precancerous lesions. Methods Seventy five patients suspected of having precancerous or cancerous lesions were examined with autofluorescence endoscopy (filtered blue light 380-460 nm) under microlaryngoscopy. Autofluorescence pictures were taken with high-solution CCD-camera for analysis, diagnosis and storage, to compare with histologic results. Results Normal laryngeal mucosa with no visible alteration and mild hyperplasia displayed the typical bright green fluorescence signal, and the areas with moderate dysplasia, severe dysplasia or carcinoma in situ, microinvasive carcinoma and infiltrating carcinoma all showed a marked change in florescence to red or violet. Thus, autofluorescence enables to distinguish between begign hyperplastic laryngeal lesions(n=30) and precancerous epithelium (n=45)with a sensitivity rate of 97.8%, and specificity rate of 86.7%. False-negative results (n=1) were caused by extreme hyperkeratosis, and false positive (n=4) were cases with scarring or inflammation. Conclusions Autofluorescence endoscopy is a less invasive method of diagnosing laryngeal cancer and its precursor, which can be manipulated easily and has high sensitivity. But there are considerable false-positive rates.