色素内镜和窄带成像技术联合放大内镜对早期结直肠癌及癌前病变的诊断价值研究

Study on the diagnostic value of chromoendoscopy and narrow-band imaging combined with magnifying endoscopy for early colorectal cancer and precancerous lesions

摘要:

目的 探究色素内镜（CE）和窄带成像技术（NBI）联合放大内镜（ME）对早期结直肠癌及癌前病变的诊断价值研究。方法 选取2023年8月－2024年7月于该院接受检查的疑似早期结直肠癌及癌前病变的患者160例。采用四格表法，分析NBI-ME和CE-ME检测早期结直肠癌及癌前病变的敏感度、特异度和准确度；采用Kappa一致性检验，分析CE-ME和NBI-ME诊断早期结直肠癌及癌前病变与病理检查的一致性。结果 病理结果显示，良性病变52例，癌前病变90例，结直肠癌18例。CE-ME检测结果显示，良性病变43例，癌前病变101例，结直肠癌16例，漏诊率为33.33%；CE-ME诊断早期结直肠癌及癌前病变与病理检查的一致性中度（Kappa = 0.605，P < 0.01），敏感度为66.67%，特异度为97.18%，准确度为93.75%。NBI-ME检查结果显示，良性病变43例，癌前病变100例，结直肠癌17例，漏诊率为16.67%，NBI-ME诊断早期结直肠癌及癌前病变与病理检查的一致性较高（Kappa = 0.714，P < 0.01），敏感度为88.33%，特异度为98.59%，准确度为96.88%。CE-ME与NBI-ME两者联合检查结果显示，良性病变56例，癌前病变86例，结直肠癌18例，漏诊率为5.56%，两者联合诊断早期结直肠癌及癌前病变与病理检查的一致性极高（Kappa = 0.857，P < 0.01），敏感度为94.44%，特异度为99.30%，准确度为98.75%，高于CE-ME和NBI-ME单独检查。结论 CE和NBI联合ME对早期结直肠癌及癌前病变具有较高的诊断价值。值得应用于临床。

Abstract:

Objective To explore the diagnostic value of the combination of chromoendoscopy (CE) and narrow-band imaging (NBI) with magnifying endoscopy (ME) for early colorectal cancer and precancerous lesions.Methods 160 patients with suspected early colorectal cancer and precancerous lesions from August 2023 to July 2024 were selected. The four-grid table method was adopted to analyze the sensitivity, specificity and accuracy of NBI-ME and CE-ME in detecting early colorectal cancer and precancerous lesions. The Kappa method was used to analyze the consistency of CE-ME and NBI-ME in the diagnosis of early colorectal cancer and precancerous lesions with pathological examination.Results The pathological results showed that there were 52 cases of benign lesions, 90 cases of precancerous lesions and 18 cases of colorectal cancer. The CE-ME test results showed that there were 43 cases of benign lesions, 101 cases of precancerous lesions, and 16 cases of colorectal cancer, with a misdiagnosis rate of 33.33%. The consistency of CE-ME in diagnosing early colorectal cancer and precancerous lesions with pathological examination was average (Kappa = 0.605, P < 0.01), with a sensitivity of 66.67%, a specificity of 97.18%, and an accuracy of 93.75%. The results of NBI-ME examination showed 43 cases of benign lesions, 100 cases of precancerous lesions, and 17 cases of colorectal cancer. The misdiagnosis rate was 16.67%. The consistency of NBI-ME in diagnosing early colorectal cancer and precancerous lesions with pathological examination was relatively high (Kappa = 0.714, P < 0.01), and the sensitivity was 83.33%. The specificity was 98.59% and the accuracy was 96.88%. The combined examination results of CE-ME and NBI-ME showed that there were 56 cases of benign lesions, 86 cases of precancerous lesions, and 18 cases of colorectal cancer. The misdiagnosis rate was 5.56%. The consistency of the combined diagnosis of early colorectal cancer and precancerous lesions with pathological examination was extremely good (Kappa = 0.857, P < 0.01). The sensitivity was 94.44%, the specificity was 99.30%, and the accuracy was 98.75%, which were higher than those of CE-ME and NBI-ME alone examinations.Conclusion The combination of CE and NBI with ME has a relatively high diagnostic value for early colorectal cancer and precancerous lesions. It is worth applying in clinical practice.