窄带成像技术下浅表型鼻咽癌黏膜表面微血管形态特点及临床价值

Mucosal microvascular morphological changes in superficial nasopharyngeal carcinoma and its clinical value under narrow band imaging

摘要:

目的??探讨窄带成像技术（NBI）下浅表型鼻咽癌（NPC）黏膜表面微血管形态特点及其临床价值。方法?对2015年1月-2016年1月该院内窥镜室行鼻咽镜常规检查或NPC放疗后复查鼻咽镜时白光镜下观察未发现明确病灶或仅为浅表型病灶的182例患者行NBI模式鼻咽镜检查，观察鼻咽部黏膜及病灶黏膜表面微血管形态特点及分布情况，结合病理结果，分析NBI下鼻咽部不同性质浅表型病变黏膜表面微血管的形态改变特点。结果?NBI下NPC组黏膜表面微血管多为密集增粗棕色窦点状（CBS）血管，占38.24%，不规则增粗树枝状血管 （IDBV） 占41.18%，病灶多有清晰边界（DL）占52.94%。其中，首诊NPC组多为IDBV （57.89%，P =0.000），放疗后NPC组多为CBS血管（60.00%，P =0.000）。NBI对NPC诊断的敏感度、特异性、阳性预测值和阴性预测值及诊断符合率分别为79.41%、95.95%、81.82%、95.30%和92.86%。结论?NBI下可观察到浅表型NPC黏膜表面微血管形态有特异性改变，对该类NPC有较高的诊断价值，从而有助于提高内镜对NPC早期病灶诊断的敏感性。

Abstract:

Objective?To evaluate the mucosal microvascular morphological changes in superficial nasopharyngeal carcinoma (NPC) and its clinical value under narrow band imaging (NBI).?Methods?From 2015.01 to 2016.01, 182 patients at high risk for NPC received biopsy of superficial nasopharyngeal lesions due to the existence of irregular vessel under NBI while they were examined with electronic nasopharyngolaryngoscope quipped with white light mode and NBI mode. Compared the mucosal microvascular morphological characteristics of different diseases based on pathological result and evaluated the diagnostic efficacy of NBI.?Result?Under NBI, the mucosal microvascular morphological characteristics of nasopharyngeal carcinoma under NBI mode were of that concentrated brown spots (CBS, 38.24 %) and irregularly dilated branching vessels (IDBV, 41.18 %) with demarcation line (DL, 52.94 %). In addition, IDBV were the main microvascular pattern in fresh NPC cases (57.89 %, P = 0.000), while CBS were the main microvascular pattern in post-radiation local recurrent NPC cases (60.00 %, P = 0.000). The sensitivity, specificity, positive predictive value, negative predictive values and diagnostic coincidence rate of NBI in NPC screening were 79.41 %, 95.95 %, 81.82 %, 95.30 % and 92.86 %, respectively.?Conclusion?NBI endoscopy is a promising tool for improving the early diagnosis of NPC by detecting mucosal microvascular morphological changes in superficial NPC.