放大内镜联合窄带成像在胃部早期肿瘤性病变患者中的应用效果

Effect of magnifying endoscopy with narrow-band imaging in diagnosis of early gastric neoplastic lesion

摘要:

目的 探讨放大内镜联合窄带成像（ME-NBI）在胃部早期肿瘤性病变患者中的应用效果。 方法 选取2013 年1 月-2016 年6 月于该院消化内镜中心行内镜检查的151 例可疑胃早癌患者为研究对象， 所有患者先行普通白光内镜（WLE）检查，然后行ME-NBI 检查和靶向活检，重点测量腺管间质距离（以下 简称腺间距），根据病理结果分为早癌组[ 高级别上皮内瘤变（HGIN）、黏膜内癌、黏膜下癌，n =72] 和非早 癌组[ 低级别上皮内瘤变（LGIN），n =79]。比较两组的基线资料和ME-NBI 征象，采用受试者工作曲线下 面积（AUC）来评价其对胃早癌的诊断价值。结果 早癌组的边界线、不规则的黏膜微血管、不规则的表面 腺管和腺间距升高的发生率明显高于非早癌组，差异有统计学意义（P <0.05）。ME-NBI 对胃早癌的AUC 为0.947，高于WLE 的0.832，具有较高的诊断价值，其灵敏度（Se）、特异度（Sp）、阳性预测值（PPV）、阴 性预测值（NPV）和Youden 指数分别为97.2%、84.8%、85.4%、97.1% 和0.820。腺间距对胃早癌的AUC 为 0.907，高于传统微血管纹理与表面结构（VS）分型的0.889，且VS 分型与腺间距进行联合诊断的AUC 达到 0.933，其Se、Sp、PPV、NPV 和Youden 指数分别为95.8%、83.5%、84.1%、95.7% 和0.794。结论 ME-NBI 是胃早癌的重要诊断方法，腺间距具有客观性强、简便易行和可重复性好的优点，能辅助传统VS 分型来判断 病变性质。

Abstract:

Objective To investigate the effect of magnifying endoscopy with narrow-band imaging (MENBI) in diagnosis of early gastric neoplastic lesion. Methods 151 patients with suspected gastric cancer underwent endoscopic examination in digestive endoscopy center from January 2013 to June 2016 were enrolled the study. They firstly received conventional white light endoscopy (WLE), then ME-NBI (including intervening part) and targeted biopsy. And all patients were divided into early cancer group (high grade intraepithelial neoplasia, intramucosal carcinoma and submucosal carcinoma, n = 72) and non-early cancer group (low grade intraepithelial neoplasia, n = 79). The area under receiver-operating characteristic curve (AUC) was performed to evaluate prognostic value of each index in early cancer. Results The incidences of the demarcation line, irregular microvascular pattern, irregular microsurface pattern and increasing intervening part in early cancer group were significantly higher than that in the non-early cancer group (P < 0.05). The AUC of ME-NBI for early gastric cancer was 0.947 and higher than 0.832 of WLE. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden index were 97.2%, 84.8%, 85.4%, 97.1% and 0.820, respectively. The AUC of intervening part for early gastric cancer was 0.907 and higher than 0.889 of the traditional VS classification, and AUC, sensitivity, specificity, PPV, NPV and Youden index of VS type combined with intervening part were 0.933, 95.8%, 83.5%, 84.1%, 95.7% and 0.794, respectively. Conclusions ME-NBI is an important method for diagnosis of early gastric cancer, and intervening part has the advantages of strong objectivity, simple and easy to operate, good repeatability, and it could be used to assist traditional VS classification in judging the nature of lesions.