普通白光内镜、超声内镜及放大内镜结合窄带显像在早期胃癌内镜治疗适应症中的临床价值

目的 探讨普通白光内镜(white light image,WLI)、超声内镜(endoscopic ultrasonography,EUS)、放大内镜结合窄带显像(magnifying endoscopy with narrow band imaging,ME-NBI)技术在早期胃癌内镜治疗适应症中的应用价值,为临床...

Clinical Value of White Light Image,Endoscopic Ultrasonography and Magnifying Endoscopy with Narrow Band Imaging in Evaluation of Indications for Endoscopic Treatment of Early Gastric Cancer

  Objective  To explore the application value of white light image (WLI), endoscopic ultrasonography (EUS) and magnifying endoscopy with narrow band imaging (ME-NBI) in the endoscopic treatment of early gastric cancer (EGC), and to provide basis for decision-making in clinical diagnosis and treatment.   Methods  The clinicopathological data of EGC patients who underwent endoscopic submucosal dissection (ESD) at West China Hospital, Sichuan University between December 2013 and October 2020 were included. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of EGC invasive depth were compared between WLI and EUS. The role of ME-NBI in predicting the differentiation types of EGC was analyzed.   Results  A total of 280 patients (291 lesions) were enrolled in the study. Among them, 199 patients (207 lesions) received EUS and 160 patients (168 lesions) received ME-NBI. The overall accuracy of WLI in diagnosing the invasive depth of EGC was 87.0%, significantly higher than that of EUS (46.4%, P<0.001). When WLI was combined with EUS, the diagnostic accuracy (87.4%) was not significantly improved. The overall accuracy of determining the differentiation degree of EGC with ME-NBI was 92.3% (155/168), and the accuracy of determining undifferentiated EGC with ME-NBI was significantly lower than that of differentiated EGC (41.2% vs. 98.0%, P<0.001).   Conclusion  In the evaluation of indications for endoscopic treatment of EGC, WLI showed better performance in predicting the invasive depth of EGC, while EUS demonstrated limited value. ME-NBI showed better accuracy for predicting the differentiation degree of most EGC, especially for differentiated EGC.