窄带成像内镜下活检术对扁桃体癌早期诊断的价值评估

Endoscopic biopsy with narrow-band imaging in the early diagnosis of tonsillar cancer

摘要:

目的 探讨窄带成像内镜（NBI）下活检术在扁桃体癌早期诊断中的应用价值。方法 选取2013年2月－2019年2月该科就诊的220例扁桃体病变患者。其中，手术治疗扁桃体肥大患者120例（Ⅱ度肥大患者80例，Ⅲ度肥大患者40例，均为单侧病变）：60例行NBI下活检术，60例行常规活检术；扁桃体癌早期患者100例（均为单侧病变）：50例行NBI下活检术，另50例行常规活检术。220例患者均经病理确诊。比较两种方法的灵敏度、特异度、诊断符合率、约登指数、阳性预测值和阴性预测值。结果 NBI下活检和常规活检的灵敏度分别为98.00%和84.00%、特异度分别为100.00%和100.00%、诊断符合率分别为99.09%和92.73%、约登指数分别为98.00%和84.00%。NBI下活检和常规活检阳性预测值为100.00%和100.00%；NBI下活检和常规活检阴性预测值为98.36%和88.24%，两种检测方法的早期扁桃体癌诊断准确率比较，差异有统计学意义（ ² = 5.98，P = 0.016）。结论 NBI下活检术对扁桃体癌早期诊断具有较高的灵敏度、特异度、阴性预测值；具有快速、准确的优点，可用于扁桃体癌的筛查和早期诊断。

Abstract:

Objective To explore the value of biopsy under narrow-band imaging (NBI) in the early diagnosis of tonsillar cancer.Methods From February 2013 to February 2019, 120 patients with tonsillar hypertrophy (including 80 patients with grade II hypertrophy and 40 patients with grade III hypertrophy, all of them were unilateral lesions): 60 patients underwent narrow-band imaging endoscopic biopsy; the other 60 patients underwent routine biopsy. 100 patients with early tonsillar carcinoma (all unilateral lesions): 50 cases underwent narrow-band imaging endoscopic biopsy; the other 50 cases underwent routine biopsy. All the 220 cases were confirmed by pathology. The sensitivity, specificity, diagnostic accuracy, Youden index, positive predictive value and negative predictive value of the two methods were compared.Results The basic characteristics of NBI biopsy and routine biopsy were as follows: the sensitivity was 98.00%, 84.00%; the specificity was 100.00%, 100.00%; the diagnostic coincidence rate was 99.09% and 92.73%; the Youden index was 98.00% and 84.00% respectively. The positive predictive value score of NBI biopsy and routine biopsy was 100.00%, 100.00%; the negative predictive value of NBI biopsy and routine biopsy was 98.36% and 88.24%. There was significant difference between the two methods in the diagnosis of early tonsillar carcinoma ( ² = 5.98, P = 0.016).Conclusion Narrow band imaging endoscopic biopsy has high sensitivity, specificity and negative predictive value for the early diagnosis of tonsil cancer. It has the advantages of fast and accurate, and can be used for screening and early diagnosis of tonsillar cancer.