窄带谱成像放大内镜技术对早期食管癌及其癌前病变诊断的临床应用价值*

Clinical application of narrow band imaging magnifying endoscopy in the diagnosis of early esophageal carcinoma and precancerous lesions*

摘要:

探讨窄带谱成像放大内镜（NBI-ME）观察下食道病变上皮乳头内血管袢（IPCL）分型对早期食管癌（EEC）及癌前病变诊断的临床价值。方法 回顾该院内镜诊治中心2013年7月－2016年12月发现的食管黏膜表面异常的102例（共132处病变）患者内镜表现和临床病理资料，分析IPCL分型对食道病变性质及浸润深度的预判作用。结果 IPCL为A型的病变中95.0%（38/40）病理诊断为食管炎，IPCL为B型的病变中96.7%（89/92）病理诊断为EEC及癌前病变；NBI-ME观察后，术前活检病理与术后完整病理一致性尚可（Kappa =0.485>0.4，P <0.01）；B1、B2、B3型IPCL预判食道病变浸润深度的准确率分别为68.0%（34/50）、73.3%（11/15）及100.0%（4/4）。结论 NBI-ME观察下对食道病变的IPCL进行AB分型，有助于对食管病变性质及浸润深度的预判，同时结合病理结果及超声内镜（EUS）等技术，可实现对病变病情的综合评估，从而可以为患者制定最佳的治疗策略。

Abstract:

To investigate the clinical value of IPCL typing for esophageal lesions in the diagnosis of early esophageal and precancerous lesions under NBI-ME.?Methods?The endoscopic findings and clinical pathological data of 102 patients (132 lesions) with esophageal mucosal abnormalities were retrospectively analyzed from July 2013 to December 2016. The IPCL classification was used to analyze the changes of esophageal disease and depth of infiltration.?Results?IPCL for type A lesions in 95.0% (38/40) pathological diagnosis of esophagitis, IPCL for type B lesions in 96.7% (89/92) pathological diagnosis of early esophageal cancer and precancerous lesions; The consistency of histopathological results between NBI-ME preoperative biopsy and postoperative general specimen were acceptable (Kappa =0.485>0.4, P<0.01); B1, B2, B3 type IPCL prejudgment the accuracy rate of depth of infiltration was 68.0% (34/50), 73.3% (11/15), and 100.0% (4/4), respectively.?Conclusion?The IPCL AB classification of the esophageal lesions under NBI-ME observation, contribute to pre-judgment of the esophageal lesions and the depth, combined with pathological results, EUS and other technologies can achieve a comprehensive assessment of the disease, which can be very useful for choosing the best treatment strategy for the patients.