소화기 전암병변의 검출을 위한 목시플록사신과 프로플라빈 이중 형광 영상의 유효성 평가: 전향적 연구

Abstract

Background and study aims: The development of endoscopic imaging enabled visual diagnosis during endoscopic sessions. High-contrast and high-resolution imaging technique may enable real-time sensitive detection of the lesions. This study aimed to investigate the feasibility of a novel dual fluorescence imaging using moxifloxacin and proflavine in premalignant and early cancerous lesions of the human gastrointestinal tract. Patients and methods: Patients with premalignant and early cancerous lesions in the colon and stomach were prospectively enrolled in this study. The lesions were biopsied with forceps or endoscopically resected. Dual fluorescence imaging was performed with topical moxifloxacin and proflavine solutions and custom axially-swept wide-field fluorescence microscopy. Results were compared with conventional histological examination. Results: Eight patients with ten colonic lesions (1 normal mucosa, 8 adenomas, 1 carcinoma) and four patients with six gastric lesions (1 normal mucosa, 3 adenomas, 3 carcinomas) were evaluated. Dual fluorescence imaging visualized detailed cellular morphology, arrangement, and structures. Regular glandular structures with polarized cell arrangement were observed in the normal mucosa tissue. Goblet cells were preserved in the normal colonic mucosa tissues. Irregular glandular structures with scanty cytoplasm and dispersed elongated nuclei were observed in the adenoma or carcinoma. Goblet cells were scarce or lost in the colonic lesions. Similarity analysis between moxifloxacin and proflavine imaging showed relatively higher correlation values in adenoma or carcinoma compared with those in normal mucosa. Dual fluorescence imaging showed good accuracy with histologic examination both in the colonic (82.3%) and gastric (86.0%) lesions. Conclusions: High-contrast high-resolution dual fluorescence imaging using moxifloxacin and proflavine was feasible for obtaining detailed histological information in the gastrointestinal premalignant and early cancerous lesions. Further studies are needed to develop dual fluorescence imaging as an in vivo real-time visual diagnostic method.