智能染色技术内镜在鼻咽部病变诊断中的应用探索

Exploration of the application of i-Scan endoscopy in nasopharyngeal lesions

摘要:

目的 比较白光内镜和智能染色技术（i-Scan）内镜对鼻咽肿物的诊断价值。方法 选择2019年1月－2021年12月于该科发现鼻咽肿物并取得活检病理结果的患者127例作为研究对象。其中，2019年1月－2020年12月使用白光内镜的59例，2021年1月－2021年12月使用i-Scan内镜的68例。以病理结果为金标准，比较两组患者的诊断准确率；评估i-Scan内镜下鼻咽肿物的微血管形态和病变边界等，并与病理结果进行相关性分析。结果 i-Scan内镜诊断鼻咽肿物的特异度和准确率高于白光内镜（91.80%和86.00%，91.17%和86.44%），敏感度低于白光内镜（85.71%和88.89%），但差异均无统计学意义（P > 0.05）； i-Scan组诊断一致性较白光组略高（Kappa值为0.619和0.588）；i-Scan组病变部位边界评分、微血管评分，以及两者总分，与病理评分呈正相关（r = 0.429，r = 0.421和r = 0.460），差异均有统计学意义（P < 0.05）；对于鼻咽癌，内镜下均观察到典型的紊乱扭曲黏膜下血管（SV）和树枝状血管（BV）等，对于大部分良性病变，内镜下可观察到扩张且分布规律的SV和BV，无论病理良恶性，鼻咽部未观察到明显的上皮内乳头状毛细血管袢（IPCL）。结论 i-Scan内镜对鼻咽肿物诊断效能高于白光内镜。

Abstract:

Objective To compare the diagnostic value of white light endoscopy and intelligent scan (i-Scan) endoscopy for nasopharyngeal masses.Methods We collected 127 patients with nasopharyngeal masses from January 2019 to December 2021 and obtained biopsy pathological results. From January 2019 to December 2020, 59 cases were treated with white light endoscopy, and from January 2021 to December 2021, 68 cases were treated with i-Scan endoscopy. Compare the accuracy of diagnosis between the two groups based on pathological results as the gold standard; Evaluate the microvascular morphology and lesion boundaries of nasopharyngeal masses under i-Scan endoscopy, and conduct correlation analysis with pathological results.Results The specificity and accuracy of i-Scan endoscopy in the diagnosis of nasopharyngeal masses were higher than those of white light endoscopy (91.80% and 86.00%, 91.17% and 86.44%), and the sensitivity was lower than that of white light endoscopy (85.71% and 88.89%), but there was no significant difference (P > 0.05). The diagnostic consistency of i-Scan group was slightly higher than that of white light group (Kappa = 0.619 and 0.588); The lesion site boundary score, microvascular score, and their total score in i-Scan group were positively correlated with the pathological score (r = 0.429, r = 0.421, r = 0.460), the differences were statistically significant (P < 0.05); Typical disordered and twisted submucosal vessels (SV) and branching vessels (BV) were observed in nasopharyngeal carcinoma, most benign lesions could observe dilated and regularly distributed SV and BV, regardless of pathological malignancy, no obvious intraepithelial papillary capillary loop (IPCL) was observed in the nasopharynx.Conclusion The diagnostic efficacy of i-Scan endoscopy for nasopharyngeal masses is higher than that of white light endoscopy.