放大胃镜结合窄带成像技术在早期胃癌中的临床应用

目的通过对比分析普通白光内镜（WLE）与放大胃镜结合窄带成像技术（ME-NBI）诊断早期胃癌的准确性,评价其临床应用价值。方法将行WLE检查发现异常病灶的166例患者纳入研究,所有患者均再次行ME-NBI检查,所有病变行组织活检或内镜下黏膜剥离术（ESD）后送检病理,以病理组织学诊断为＂金标准＂,并将结果进行对比分析。结果 166例患者中,病理组织学证实非癌性病变为118处,癌性病变48处。WLE诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为100%、22.88%、34.53%、100%和45.18%,ME-NBl对应值分别为81.25%、90.68%、78.00%、92.24%和87.95%,ME-NBI诊断早期胃癌的准确性明显高于WLE（P〈0.01）。黏膜腺管开口形态紊乱不规则或消失、微血管形态紊乱不规则或毛细血管网消失、病变与黏膜组织分界清楚是早期胃癌在ME-NBI下最具特征性的3个改变,其中以微血管形态紊乱不规则或毛细血管网消失相对最为重要。结论 WLE是筛查早期胃癌首选方法之一。对WLE发现的疑似病变进一步行ME-NBI检查有助于进一步明确诊断。

Clinical application of magnifying endoscopy combined with narrow-band imaging in early gastric cancer

Objective To compare the diagnosis accuracy ofwhite lightendoscopy（WLE） and magnifying endoscopy combined with narrow-band imaging（ME-NBI）, and to evaluate their clinical application value. Methods One hundred and sixty-six cases of abnormal lesion discovered by white light endoscopy examination were included in this research, who underwent magnifying endoscopy combined with narrow-band imaging examination, and all the lesions were sent for biopsy or endoscopic submucosal dissection（ESD） after pathology, with histopathological diagnosis as the ＂gold standard＂, and the results were compared. Results Among 166 patients, non cancerous lesions were confirmed in 118 foci by pathohistology and carcinoma lesions in 48 foci. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of WLE in the diagnosis of early gastric cancer were 100%, 22.88%,34.53%, 100% and 45.18%, and the corresponding values of ME-NBI were 81.25%, 90.68%, 78.00%,92.24% and87.95%. The accuracy of ME-NBI in diagnosis of early gastric cancer was significantly higher than that of WLE（0.01）. There were three characteristic changes in the ME-NBI diagnosis of early gastric cancer, such as mucosal crypt disorder or disappear, microvessel disorder or capillary network disappeared, and clear demarcation between lesions and mucosa. The microvascular disorder or capillary network was the most important. Conclusions WLE is the preferred method for screening early gastric cancer. For suspected cases of white light endoscopy, ME-NBI examination is helpful to the further diagnosis.