高分辨率显微内镜对食管鳞状细胞癌标本的成像研究*

High resolution microendoscopy for esophageal squamous cell carcinoma specimens*

摘要:

目的   探索高分辨率显微内镜（HRME）对食管鳞状细胞癌（ESCC）标本成像的可行性。方法   回顾性分析24例ESCC大体标本的正常食管黏膜和ESCC组织的HRME图片，总结图片特点，制定正常食管黏膜和ESCC组织的HRME诊断标准。在此基础上，对60例内镜下疑诊为鳞状细胞癌的活检标本进行HRME前瞻性研究，将HRME预诊断结果与病理结果比较，评估HRME对食管鳞状细胞癌的诊断价值。结果   正常食管黏膜HRME特点为：细胞排列规则，细胞核圆而亮，大小一致，核间距正常，视野里细胞的数量基本一致；ESCC组织HRME特点为：细胞排列极其紊乱，失去极性，细胞核大小不一，核间距减小，出现了大量细胞核的叠加，细胞核增大，每个视野中都为杂乱分布的细胞核。对60例内镜下疑诊为ESCC的活检标本HRME成像后，HRME预诊断为正常食管黏膜4个，鳞状细胞癌52个，其他4个。病理检查后，诊断为正常食管黏膜3个，鳞状细胞癌53个，其他4个。经统计学分析，HRME对鳞状细胞癌诊断的敏感度、特异度、准确性、阴性预测值和阳性预测值分别为96.2%、85.7%、95.0%、75.0%和98.1%。结论   HRME可以很好地区分正常食管黏膜和鳞状细胞癌组织，其能很好的对鳞状细胞癌标本进行成像。

Abstract:

Objective To explore the feasibility of high resolution microendoscopy in the imaging of esophageal squamous cell carcinoma specimen. Methods Retrospective analysis of 24 cases of esophageal squamous cell carcinoma of the gross specimens of normal esophageal mucosa and squamous cell carcinoma tissues HRME images, summarizes the image characteristics, develop HRME of normal esophageal mucosa and squamous cell carcinoma tissue diagnosis standard. Based on the developed diagnostic criter, we made a prospective study and the specimen from the suspected of squamous cell carcinoma in 60 cases. Comparing the prepressing diagnosis of HRME with the pathological results, aiming to evaluate the diagnostic value of HRME for ESCC. Results The characteristic of normal esophageal mucosa of HRME images: cells were arranged in an orderly manner, the nucleus was round, light and identical in size, the inter-nuclear distance was normal, and the number of cells in each field was similar; The diagnostic criteria for ESCC were as follows: cell arrangement was significantly disordered, cells had no polarity, the nuclei were of different sizes, inter-nuclear distance was reduced, nuclear overlapping was found in a large number of cells, the nuclei were enlarged, and disordered distribution of the nuclei was observed in each field. After imaging, HRME was diagnosed as normal esophageal mucosa at 4 sites, squamous cell carcinoma at 52 sites, and the other at 4 sites. After pathological examination, the diagnosis normal esophageal mucosa was 3, squamous cell carcinoma was 53 and the other was 4. The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of HRME in the diagnosis of squamous cell carcinoma were 96.2%, 85.7%, 75.0%, 95.0%, 98.1%, respectively. Conclusions HRME can distinguish normal esophageal mucosa and squamous cell carcinoma tissues and it can be used for imaging of squamous cell carcinoma specimen.