摘要
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。
Objective To evaluate magnifying endoscopy combined with narrow-band imaging （ ME- NBI） for diagnosis of early gastric cancer （EGC）. Methods A total of 150 focal lesions from 143 patients over 35 years old identified by white light endoscopy （WLE） from March 2010 to December 2010 in our tertiary referential institution were recruited in the prospective study with written informed consent. Focal lesions were defined as any small local mucosa with abnormal shape or color based on an assessment of findings of WLE without any specified criteria, including superficial, depressed and elevated lesions. The patients with local advanced gastric cancer, submucosal lesions and history of gastrectomy were excluded from the study. All the patients received ME-NBI. Based on literature, national criteria of early diagnosis with ME- NBI were established. All the lesions underwent biopsy and pathological examination. Diagnostic accuracy of ME-NBI for EGC was assessed with reference to histopathology. Results In 150 focal lesions, 19 were pathologically diagnosed as EGC, 8 of which were treated by endoscopic resection and 11 were resected surgically. The sensitivity, specificity, positive predictive value （pPV）, negative predictive value （NPV） and accuracy of conventional WLE for diagnosing EGC were 94. 7%, 53.4%, 22. 8%, 98.6% and 58.7%, respectively. The counterparts of ME-NBI for diagnosing EGC were 73.7%, 99. 2%, 93.3% , 96. 3% and 96. 0%, respectively. The diagnostic accuracy of ME-NBI was significantly better than that of conventional WLE （96.0% vs. 58. 7%, P 〈0.05）. With regard to the findings of EGC on ME-NBI, irregular or absent microsurface pattern and mierovascular pattern were characteristic features of EGC. Conclusion Conventional WLE is still an important and mandatory screening modality, which is significant for further procedures of suspected lesions, preferably accompanied with biopsy. ME-NBI achieved superior accuracy in the differential diagnosis of focal lesions detected with conventional WLE, but needs further verification.
出处
《中华消化内镜杂志》
北大核心
2011年第7期375-379,共5页
Chinese Journal of Digestive Endoscopy
基金
卫生行业公益专项资助（200902002）
关键词
早期诊断
胃肿瘤
放大胃镜
窄带成像技术
Early diagnosis
Stomach neoplasms
Magnifying endoscopy
Narrow-band imaging
