窄带成像放大内镜指导靶向活检对早期食管癌诊断的临床价值*

Clinical value of magnifying endoscopy-narrow band imaging in diagnosis of early esophageal cancer*

摘要:

评估窄带成像放大内镜（ME-NBI）在早期食管癌诊断中指导靶向活检的临床价值。方法 将2015年10月－2017年12月经普通白光内镜（C-WLI）检查发现食管黏膜早期病变并取得病理的患者纳入研究，进一步行ME-NBI精查并指导靶向活检，有一次病理诊断阳性者即行内镜下治疗。以内镜下切除后病理结果为金标准，比较两种内镜指导病理的诊断准确度。结果 ①研究共纳入91例患者，其中4例术前病理均为黏膜炎症，未行内镜下治疗，余87例均行内镜下切除，C-WLI指导病理、ME-NBI靶向病理与术后病理比较，总体符合率由18.39%（16/87）提高为88.50%（77/87），差异有统计学意义（P<0.05）；②对早期食管癌和高级别上皮内瘤变（HGIN）的诊断，ME-NBI靶向病理与C-WLI指导病理的灵敏度分别为92.18%和33.33%，准确度分别为91.67%和60.86%，差异均有统计学意义（P<0.05）；③ME-NBI通过观察毛细血管袢（IPCL）变化可以评价病变浸润深度，对术前评估起到指导性作用。结论 对于早期食管癌的诊断，ME-NBI指导靶向病理结果明显优于C-WLI指导病理，故ME-NBI内镜可作为早期食管病变精查和评价病变浸润深度的检查方法。

Abstract:

To evaluate the clinical value of magnifying endoscopy-narrow band imaging (ME-NBI) for targeting biopsy of lesions in the early esophageal cancer. Methods 91 patients with suspicious early esophageal lesions under common white light imaging (C-WLI) were prospcetively entrolled and biopsied from October 2015 to December 2017. Further endoscopy was conducted using ME-NBI and target biopsy. 87 patients receved endoscopic resection (ER). Outcomes of WLI biopsy and ME-NBI target biopsy,with histology of ER specimen as golden standard. Results The overall diagnostic accuracy of C-WLI biopsy and target biopsy were increased from 18.39% (16/87) to 88.50% (77/87), with statistically significant difference (P<0.05); In diagnosing early esophageal cancer and high-grade intraepithelial neoplasia, the sensitivity of ME-NBI targeted biopsy and C-WLI biopsy were 92.18% and 33.33%, The accuracy were 91.67% and 60.86%, respectively. All the differences were statistically significant (P<0.05); ME-NBI can evaluate the infiltration depth of lesions by observing the changes of IPCL, playing a guiding role in preoperative evaluation. Conclusion In the diagnosis of early esophageal cancer, ME -NBI targeted biopsy is superior to the C-WLI biopsy, ME-NBI can be used in checking infiltration depth inspection of early esophageal cancer.