放大内镜用于早期胃癌的诊断

胃癌是世界上最常见的恶性肿瘤之一, 通过早期诊断, 可以明显降低胃癌的死亡率。临床上常用的诊断方法 为电子胃镜, 放大内镜为临床上常见的电子胃镜诊断方法之一。文章主要阐述放大内镜及放大内镜联合其他内镜 技术对早期胃癌诊断的进展。     

窄带成像技术结合放大内镜在早期胃癌诊断中的价值研究

目的评价窄带成像技术（NBI）结合放大内镜在早期胃癌诊断中的应用价值。方法2008年3月至2008年12月经普通内镜发现存在胃黏膜可疑病灶且符合研究要求的患者共56例,行NBI结合放大内镜及靛胭脂染色检查,对NBI、靛胭脂染色诊断的胃黏膜腺管及微血管形态的清晰程度评分进行比较。内镜检查之后对所检查部位进行靶向活检,将NBI结合放大内镜及靛胭脂染色检查结果及病理检查结果进行比较。结果56例中有16例经病理诊断为早期胃癌。将NBI结合放大内镜及靛胭脂染色检查结果及病理检查结果进行统计得出：NBI结合放大内镜诊断早期胃癌的诊断符合率、敏感性、特异性、假阳性率、假阴性率分别为94．6％（53／56）、93．8％（15／16）、95．0％（38／40）、5．0％（2／40）、6．3％（1／16）;靛胭脂染色诊断早期胃癌的诊断符合率、敏感性、特异性分别为91．1％（51／56）、87．5％（14／16）、92．5％（37／40）,假阳性率、假阴性率分别为7．5％（3／40）、12．5％（2／16）;二者比较差异均无统计学意义（P均〉0．05）。NBI、靛胭脂染色诊断的胃黏膜腺管及微血管形态的清晰程度评分结果对比显示：NBI与靛胭脂染色在腺管结构显示方面无明显差别,但NBI显示微血管形态明显优于靛胭脂染色。结论NBI结合放大内镜可以提供清晰的胃黏膜血管图像,有助于早期胃癌的诊断,可提高活检检查的准确性,与靛胭脂染色联用可提高早期胃癌的诊断率。     

智能染色内镜对早期胃癌的诊断价值探讨

目的探讨富士能智能染色内镜（FICE）在早期胃癌中的诊断价值。方法2010年2月至2011年3月经普通胃镜检查后疑似早期胃癌的患者67例,分别行电子放大内镜、FICE染色放大内镜、靛胭脂染色放大内镜检查。对疑似病灶的胃黏膜腺管及微血管形态的清晰程度进行评分比较,并对疑似部位进行靶向活检,比较3种内镜诊断早期胃癌的敏感度、特异度以及与病理组织学的符合率。结果67例患者中,经病理组织学检查诊断为早期胃癌17例。FICE染色放大内镜与电子放大内镜、靛胭脂染色放大内镜在观察腺管结构显示方面差异无统计学意义（P〉0．05）。在观察微血管形态方面,FICE染色放大内镜明显好于电子放大内镜、靛胭脂染色放大内镜（P〈0．05）。在诊断早期胃癌的敏感度、特异度以及与病理组织学的符合率方面,FICE染色放大内镜分别为94．1％（16／17）、98．0％（49／50）、97．0％（65／67）,靛胭脂染色放大内镜分别为88．2％（15／17）、96．0％（48／50）、94．0％（63／67）,电子放大内镜分别为58．8％（10／17）、84．0％（42／50）、77．6％（52／67）,FIEC染色放大内镜均明显高于电子放大内镜（P〈0．05）,且均与靛胭脂染色放大内镜相近（P〉0．05）。结论FICE染色放大内镜可以更方便地提供清晰的血管图像,有助于早期胃癌的诊断,提高活检检查的准确率。     

放大内镜窄带成像联合活检在早期胃癌诊断中的价值

目的 分析放大内镜窄带成像(ME-NBI)联合活检在早期胃癌(EGC)诊断中的价值。方法 回顾性分析2019年1月至2021年12月在蚌埠市第三人民医院经普通白光胃镜检查发现胃黏膜可疑EGC的患者,并行内镜下切除(ER)包括内镜下黏膜剥离术(ESD)或内镜下黏膜切除术(EMR)的病例,依据术前最后一次内镜检查方法不同进行分组,分为普通白光胃镜(WLE)活检组、ME-NBI组和ME-NBI联合活检组,比较三组对病灶的术前诊断结果与术后病理诊断结果的一致性。结果WLE活检组、ME-NBI及ME-NBI联合活检对病灶的术前诊断与术后病理诊断一致率分别为77.8%、80.6%、97.2%,ME-NBI活检组在诊断癌性病变的正确率97.2%、灵敏度92.9%、特异度100%、阳性预测值100%、阴性预测值95.7%。结论 ME-NBI联合活检对EGC的诊断具有较高的准确率,优于WLE活检及单纯ME-NBI检查,值得在EGC诊断中推广应用。     

采用色素放大内镜对124例老年早期胃癌患者的临床诊断

<正>早期胃癌的发病率随着年龄的增加而显著增加,近年来呈现年轻态趋势;手术切除是目前临床上最主要的治疗手段。早期胃癌的预后较好,5年生存期可达到90%以上,但进展期胃癌预后较差且5年生存期不超过15%〔1〕。因此,胃癌预后的关键在于早期诊断和治疗,但目前我国早期胃癌的诊断率低于10%〔2〕。本文旨在探讨色素内镜在早期胃癌中的诊断价值。1资料与方法1.1临床资料将我院2007年8月至2012年7月收治的具     

窄带成像联合放大内镜在早期胃癌诊断中的价值

目的 分析放大胃镜+窄带成像(ME-NBI)鉴别早期胃癌的临床价值。方法 选取2016年12月至2022月6月在我院检查60例可疑胃早癌患者为研究对象,所有患者均进行腹部增强CT检查、普通白光内镜(WLE)检查和ME-NBI检查,并以病理活检为金标准,分析三种检查手段对早期胃癌的诊断价值。结果 60例可疑胃早癌患者中病理检出胃癌患者23例(38.33%),萎缩性胃炎并肠化患者34例(56.67%),慢性胃炎患者3例(5%)。ME-NBI对萎缩性胃炎并肠化患者的检出率高于腹部增强CT和WLE(腹部增强CT0例,WLE检查24例,ME-NBI检查31例,P<0.05)。腹部增强CT检查早期胃癌阳性患者17例,阴性患者43例;WLE检查早期胃癌阳性患者20例,阴性患者40例;ME-NBI检查早期胃癌阳性患者21例,阴性患者39例。腹部增强CT特异度、灵敏度、阳性预测值、阴性预测值以及准确度均低于WLE和ME-NBI,P<0.05。WLE和ME-NBI检查早期胃癌的阴性预测值相比差异无统计学意义(P>0.05);ME-NBI检查早期胃癌的灵敏度、特异度、阳性预测值、准确度均高...     

放大内镜在早期胃癌中的应用进展

放大内镜在早期胃癌的诊断中具有重要作用。近年来,针对放大内镜用于背景胃黏膜诊断,早期胃癌筛查,早期胃癌定性诊断、边界诊断及组织类型诊断,以及放大内镜与人工智能联合应用等方面有进一步研究。针对相关研究进展作一综述。     

根治幽门螺杆菌对早期胃癌内镜诊断的影响

目的 探索根治幽门螺杆菌（Helicobacter pylori,HP）对传统白光内镜、醋酸靛胭脂染色内镜及窄带光成像放大内镜诊断早期胃癌的影响。方法 2013年1月至2018年3月,于武汉大学人民医院鄂州医院消化内科或华中科技大学同济医学院附属协和医院消化内科拟行内镜检查,HP阴性（于6个月前成功根治）和HP阳性（近6个月未曾行HP根治治疗）者纳入研究,按普通“白光-醋酸靛胭脂染色-窄带光成像放大”流程行内镜检查,在最终经组织学病理确诊为早期胃癌的患者中,连续收集HP阴性（于6个月前成功根治）和HP阳性（近6个月未曾行HP根治治疗）患者各120例,分别纳入HP成功根治组和未行HP根治组。对2组早期胃癌的白光内镜、醋酸靛胭脂染色内镜、窄带光成像放大内镜检出率行统计学分析。结果 2组间病例医院来源构成（χ2=2.637, P=0.104）、患者性别构成（χ2=0.074, P=0.785）、患者平均年龄（t=0.582, P=0.561）、病变形态构成（χ2=0.179, P=0.914）比较,差异均无统计学意义。普通白光内镜、醋酸靛胭脂染色内镜、窄带光成像放大内镜的早期胃癌检出率,HP成功根治组中分别为75.0%（80/120）、57.5%（69/120）、90.0%（108/120）,未行HP根治组中分别为81.7%（98/120）、93.3%（112/120）、98.3%（118/120）。HP成功根治组早期胃癌的普通白光内镜检出率（χ2=7.046, P=0.008）、醋酸靛胭脂染色内镜检出率（χ2=41.554, P＜0.001）、窄带光成像放大内镜检出率（χ2=7.585, P=0.006）均明显低于未行HP根治组。HP成功根治组中,醋酸靛胭脂染色内镜的早期胃癌检出率最低,低于普通白光内镜（χ2=2.142, P=0.143）及窄带光成像放大内镜（χ2=32.736, P＜0.001）,而窄带光成像放大内镜的早期胃癌检出率最高,高于普通白光内镜（χ2=19.247, P＜0.001）。结论 根治HP后早期胃癌的普通白光内镜、醋酸靛胭脂染色内镜和窄带光成像放大内镜诊断变得更加困难,尤其是对醋酸靛胭脂染色内镜的影响更为明显。上述3种内镜检查方法中,窄带光成像放大内镜的诊断效能最高,适合于根治HP后早期胃癌的临床诊断。     

早期胃癌内镜诊断进展

胃癌的死亡率位居全球肿瘤死亡率的第二位.早期胃癌(EGC)预后较好,而进展期胃癌预后较差,因此胃癌的早期诊断成为决定患者预后的关键.因目前胃癌的诊断主要依赖于胃镜下活检行组织病理学检查,所以胃镜下如何发现病灶并准确活检是胃癌早期诊断的关键.随着染色内镜、放大内镜、窄带成像内镜、共聚焦显微内镜等检查手段投入临床使用,EG...     

Novel narrow-band imaging magnifying endoscopic classification for early gastric cancer

Background

Narrow-band imaging magnifying endoscopy is widely used in Japan, but still there is no set of consistent guidelines for gastric lesions.

Aims

To introduce a new narrow-band imaging magnifying endoscopic classification and report the accuracy of diagnosis in comparison to underlying histopathology of gastric lesions.

Methods

Two hundred and fifty-seven consecutive patients with early gastric cancer lesions were enrolled into this study. Narrow-band imaging magnifying images were classified into four categories based on abnormal microvascular patterns and irregularities in the superficial glandular structure: fine-network pattern, corkscrew pattern, intra-lobular loop pattern-1 and intra-lobular loop pattern-2. The narrow-band imaging magnifying endoscopic classification was compared with the histopathological findings.

Results

Amongst the differentiated-type adenocarcinoma lesions, fine-network pattern, intra-lobular loop pattern-1, intra-lobular loop pattern-2 and corkscrew pattern were observed in 15.7%, 59.6%, 24.2% and 0.5%, respectively. Differentiated-type adenocarcinomas mainly exhibited fine-network pattern or intra-lobular loop pattern. In undifferentiated-type adenocarcinoma lesions, intra-lobular loop pattern-2 and corkscrew pattern were observed in 41.2% and 58.8%, respectively. Therefore, undifferentiated-type adenocarcinomas were all classified as intra-lobular loop pattern-2 and corkscrew pattern. The histopathological types were not equivalent with the narrow-band imaging magnifying classification categories (P < 0.001).

Conclusions

The new narrow-band imaging magnifying classification that incorporates the intra-lobular loop pattern may be able to predict the histological subtype of most gastric carcinomas.     

Diagnostic performance of magnifying narrow-band imaging for early gastric cancer: A meta-analysis

AIM: To investigate the performance of magnifying endoscopy with narrow-band imaging (ME-NBI) in the diagnosis of early gastric cancer (EGC).METHODS: Systematic literature searches were conducted until February 2014 in PubMed, EMBASE, Web of Science, Ovid, Scopus and the Cochrane Library databases by two independent reviewers. Meta-analysis was performed to calculate the pooled sensitivity, specificity and diagnostic odds ratio and to construct a summary receiver operating characteristic (ROC) curve. Subgroup analyses were performed based on the morphology type of lesions, diagnostic standard, the size of lesions, type of assessment, country and sample size to explore possible sources of heterogeneity. A Deeks’ asymmetry test was used to evaluate the publication bias.RESULTS: Fourteen studies enrolling 2171 patients were included. The pooled sensitivity, specificity and diagnostic odds ratio for ME-NBI diagnosis of EGC were 0.86 (95%CI: 0.83-0.89), 0.96 (95%CI: 0.95-0.97) and 102.75 (95%CI: 48.14-219.32), respectively, with the area under ROC curve being 0.9623. Among the 14 studies, six also evaluated the diagnostic value of conventional white-light imaging, with a sensitivity of 0.57 (95%CI: 0.50-0.64) and a specificity of 0.79 (95%CI: 0.76-0.81). When using “VS” (vessel plus surface) ME-NBI diagnostic systems in gastric lesions of depressed macroscopic type, the pooled sensitivity and specificity were 0.64 (95%CI: 0.52-0.75) and 0.96 (95%CI: 0.95-0.98). For the lesions with a diameter less than 10 mm, the sensitivity and specificity were 0.74 (95%CI: 0.65-0.82) and 0.98 (95%CI: 0.97-0.98).CONCLUSION: ME-NBI is a promising endoscopic tool in the diagnosis of early gastric cancer and might be helpful in further target biopsy.     

Diagnosis of early gastric cancer using narrow band imaging and acetic acid

AIM: To determine whether the endoscopic findings of depressed-type early gastric cancers(EGCs) could precisely predict the histological type.METHODS: Ninety depressed-type EGCs in 72 patients were macroscopically and histologically identified. We evaluated the microvascular(MV) and mucosal surface(MS) patterns of depressed-type EGCs using magnifying endoscopy(ME) with narrow-band imaging(NBI)(NBI-ME) and ME enhanced by 1.5% acetic acid, respectively. First, depressed-type EGCs were classified according to MV pattern by NBI-ME. Subsequently, EGCs unclassified by MV pattern were classified according to MS pattern by enhanced ME(EME) images obtained from the same angle.RESULTS: We classified the depressed-type EGCs into the following 2 MV patterns using NBI-ME: a fine-network pattern that indicated differentiated adenocarcinoma(25/25, 100%) and a corkscrew pattern that likely indicated undifferentiated adenocarcinoma(18/23, 78.3%). However, 42 of the 90(46.7%) lesions could not be classified into MV patterns by NBI-ME. These unclassified lesions were then evaluated for MS patterns using EME, which classified 33(81.0%) lesions as MS patterns, diagnosed as differentiated adenocarcinoma. As a result, 76 of the 90(84.4%) lesions were matched with histological diagnoses using a combination of NBI-ME and EME.CONCLUSION: A combination of NBI-ME and EME was useful in predicting the histological type of depressedtype EGC.     

Diagnostic ability of blue laser imaging combined with magnifying endoscopy for early esophageal cancer

BackgroundBlue laser imaging (BLI) is a new image-enhanced endoscopy technique that utilizes a laser light source developed for narrow-band light observation.AimsTo evaluate the value of BLI combined with magnifying endoscopy (M-BLI) for the diagnosis of early esophageal cancers (EECs).MethodsThis single-center prospective study analyzed 149 patients with focal esophageal lesions detected with white light endoscopy (WLE) at Renmin Hospital of Wuhan University between April 2015 and June 2017. In this study, patients were examined sequentially with narrow-band imaging combined with magnifying endoscopy (M-NBI), M-BLI and 1.25% Lugol’s iodine chromoendoscopy. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated using the agreement (kappa) test. The paired chi-square test was used to compare the concordance of M-NBI, M-BLI and Lugol’s iodine chromoendoscopy.ResultsThis study analyzed 153 lesions (four patients had two lesions each). The sensitivity, specificity, accuracy, concordance rates and kappa value of M-BLI were 95.2%, 91.9%, 85.7%, 92.8% and 0.891, respectively; those of M-NBI were 95.2%, 92.8%, 87.5%, 93.5% and 0.906; and those of Lugol’s iodine chromoendoscopy were 95.2%, 94.6%, 91.3%, 94.8% and 0.936.ConclusionM-BLI has a diagnostic profile similar to that of M-NBI and could improve the accuracy of EEC diagnosis.     

醋酸联合窄带成像放大内镜在结直肠小息肉诊断中的价值

目的 探讨醋酸联合窄带成像放大内镜（NBI-ME）在结直肠小息肉诊断中的价值。 方法 对行内镜治疗的122例261个肠息肉依次采用放大内镜（ME）、NBI-ME和醋酸联合NBI-ME模式观察病灶,保留图像。分别由3位有放大内镜诊断经验的内镜医师（专家）及3位无放大内镜诊断经验的内镜医师（非专家）独立观察图像,图像评估依据工藤腺管开口形态分型诊断标准。以组织病理诊断为金标准,评价不同放大内镜模式对结直肠小息肉诊断的准确性,并对各种放大模式下图像的清晰度及观察者间的一致性进行对比分析。 结果 专家组ME、NBI-ME、醋酸联合NBI-ME模式诊断结直肠肿瘤性小息肉的准确率分别为65.5％（171／261）、90.0％（235／261）、94.6％（247／261）,非专家组分别为57.1％（149／261）、83.1％（217／261）、89.3％（233／261）。专家组、非专家组醋酸联合NBI-ME模式诊断结直肠肿瘤性小息肉的准确率明显高于NBI-ME（P均＜0.05）和ME模式（P均＜0.001）。专家组、非专家组醋酸联合NBI-ME模式清晰度评分均明显大于NBI-ME、ME模式（P均＜0.001）。观察者间一致性评价显示,专家组ME、NBI-ME及醋酸联合NBI-ME模式诊断结直肠肿瘤性小息肉的Kappa值（95％CI）分别为0.578 （0.508～0.648）、0.669 （0.599～0.739）、0.940 （0.870～1.010）,非专家组分别为0.476 （0.406～0.546）、 0.534 （0.464～0.604）、 0.830 （0.760～0.900）;醋酸联合NBI-ME模式一致性好。 结论 醋酸联合NBI-ME对结直肠小息肉性质的诊断准确性和可重复性较高。     

Prediction of submucosal gastric cancer by narrow-band imaging magnifying endoscopy

BackgroundThe features of gastric submucosal cancer revealed by magnifying endoscopy have not been reported. Aim of our study was to investigate whether magnifying endoscopy could contribute to the diagnosis of submucosal invasion.Patients and methodsIn this prospective, cross-sectional study, 197 lesions of gastric differentiated adenocarcinoma, diagnosed as mucosal cancer by conventional endoscopy, were observed by magnifying endoscopy with narrow-band imaging, paying attention to the presence of a blurry mucosal pattern and an irregular mesh pattern. After endoscopic submucosal dissection, all lesions were examined histologically and the areas of two features were estimated.ResultsAmong the lesions examined, 177 were diagnosed histologically as mucosal cancer and 20 as submucosal cancer. Multivariate logistic regression analysis confirmed that a blurry mucosal pattern (odds ratio 12.15, 95% confidence interval 3.45–42.76, p = 0.000) and an irregular mesh pattern (22.55, 4.22–120.45, p = 0.000) were independent predictors of submucosal invasion.ConclusionsNarrow band imaging magnifying endoscopic features are useful for predicting submucosal invasion in gastric cancer.     

放大胃镜结合窄带成像技术在早期胃癌诊断中的应用价值研究

目的通过分析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2010年3月至2010年12月行普通白光内镜（WLE）检查发现局灶性病变且年龄大于35岁的143例患者150处病灶纳入研究,局灶性病变包括黏膜形态异常（隆起、凹陷及粗糙不平整）和黏膜色泽异常（较周围黏膜发红或发白）,将进展期胃癌、黏膜下病变及有胃手术史者排除出研究。所有患者签署知情同意书后接受ME—NBI检查,参照国外最新相关文献研究结果,研究中初步建立了一个ME-NBI诊断早期胃癌的国内标准,以此标准对病变作出诊断。所有病变进行组织活检后送检病理,以病理组织学诊断为金标准,分析ME-NBI诊断早期胃癌的准确性。结果150处局灶性病变中,病理组织学证实非癌性病变为131处,癌性病变19处（8处病变行内镜黏膜下剥离术治疗,11处病变行手术治疗）。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94．7％、53．4％、22．8％、98．6％和58．7％,ME-NBI对应值分别为73．7％、99．2％、93．3％、96．3％和96．0％,ME-NBI诊断早期胃癌的准确性明显高于WLE（P〈0．05）。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是早期胃癌在ME—NBI下最为特征性的改变。结论WLE仍是早期胃癌筛查首选的检查方法,对疑似病变进一步行ME—NBI检查具有重要意义,如条件不允许则要尽可能地进行组织学活检;提出的ME-NBI诊断标准诊断早期胃癌的准确性令人满意,但最终还需要进行多中心的研究来进一步验证。     

放大内镜在胃部疾病诊断中的应用

放大内镜在消化道疾病尤其胃癌及癌前病变的诊断方面有着独特优势,并能指导活检,避免不必要的活检创伤,有着普通内镜所不能比拟的优势.本文对近年来放大内镜在胃部疾患的应用进展作一综述,同时结合临床操作体会,总结放大内镜的操作要领.     

Histopathological validation of magnifying endoscopy for diagnosis of mixed-histological-type early gastric cancer

BACKGROUND The undifferentiated-type(UDT) component profoundly affects the clinical course of early gastric cancers(EGCs). However, an accurate preoperative diagnosis of the histological types is unsatisfactory. To date, few studies have investigated whether the UDT component within mixed-histological-type(MT) EGCs can be recognized preoperatively.AIM To clarify the histopathological characteristics of the endoscopically-resected MT EGCs for investigating whether the UDT component could be recognized preoperatively.METHODS This was a single-center retrospective study. First, we attempted to clarify the histopathological characteristics of the endoscopically-resected MT EGCs with emphasis on the UDT component. Histopathological examination investigated each lesion's UDT component:(1) Whole mucosal layer occupation of the UDT component;(2) UDT component exposure to the surface of the mucosa; and(3) existence of a clear border between the differentiated-type and UDT components.Then, preoperative endoscopic images with magnifying endoscopy with narrowband imaging(ME-NBI) were examined to identify whether the endoscopic UDT component finding was recognizable within the area where it was present in the histopathological examination. The preoperative biopsy results and comparative relationships between endoscopic and histopathological findings were also examined.RESULTS In the histopathological examination, the whole mucosal layer occupation of the UDT component and exposure of the UDT component to the mucosal surface were observed in 67.3%(33/49) and 79.6%(39/49) of samples, respectively. A clear distinction of the border between the differentiated-type and UDT components could not be drawn in 65.3%(32/49) of MT lesions. In the endoscopic examination, the preoperative endoscopic images showed that only 24.5%(12/49) of MT EGCs revealed the UDT component within the area where it was present histopathologically. Histopathological UDT predominance was the single significant factor associated with the presence of the endoscopic UDT component finding(61.5% vs 11.1%, P = 0.0009). Only 26.5%(13/49) of the lesions were diagnosed from the pretreatment biopsy as having a UDT component. Combined results of the pretreatment biopsy and ME-NBI showed the preoperative presence of the UDT component in 40.8%(20/49) of MT EGCs.CONCLUSION Recognition of a UDT component within MT EGCs is difficult even when pretreatment biopsy and ME-NBI are combined. Endoscopic resection plays a significant role in both treatment and diagnosis.