窄带成像技术诊断早期食管癌及其癌前病变的临床应用价值  

Evaluation of narrow-banding imaging endoscopy in the diagnosis of early squamous esophageal cancer and precancerous lesions

作　　者：张月明[1] 贺舜[1] 郝长青[2] 张蕾[1] 赖少清[1] 吕宁[3] 倪晓光[1] 姚汉清[1] 于桂香[1] 鞠凤环[1] 荀华英[1] 程荣荣[1] 王贵齐[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院内镜科,北京100021 [2]河南省林州市肿瘤医院内镜科 [3]中国医学科学院中国协和医科大学肿瘤医院病理科,北京100021

出　　处：《中华消化内镜杂志》2007年第6期410-414,共5页Chinese Journal of Digestive Endoscopy

基　　金：卫生部部署(管)医院临床学科重点项目(NO.[2004-006]321号)

摘　　要：目的探讨窄带成像技术(narrow-banding imaging,NBI)在早期食管癌及其癌前病变诊断中的临床应用价值。方法在白光和 NBI 模式下观察食管黏膜,记录病变的大小、范围,同时进行NBI 分级。再应用 NBI 结合放大内镜观察病变部位上皮乳头内毛细血管袢(intrapapillary capillaryloop,IPCL)形态,同时进行 IPCL 形态分型。最后应用1.2%碘液进行全食管染色,记录碘染色阳性部位大小、范围,并进行碘染色分级。对于 NBI 模式阴性而碘染色阳性的病变,再次应用 NBI 结合放大内镜进行检查。对所有 NBI 阳性及碘染色阳性部位均取活检。以病理结果作为诊断金标准,将其他检查结果与之作对照。结果 (1)应用白光、NBI 模式及碘染色检查72例患者中共发现104个病变。其中白光模式下,高年资和低年资内镜医师对病变检出率分别为82.7%(86/104)和70.2%(73/104);应用 NBI 模式及碘染色后两位医师对病变的检出率相同,NBI 模式均为86.5%(90/104),碘染色均为100.0%。(2)所有高级别黏膜内瘤变碘染色阳性,其中83.0%(39/47)碘染色分级为Ⅰ级;所有低级别黏膜内瘤变碘染色也为阳性,但其中87.2%(41/47)碘染色分级为Ⅱ、Ⅲ级。(3)91.5%(43/47)高级别黏膜内瘤变 NBI 阳性,其中69.8%(30/43)NBI 分级为Ⅰ级;57.4%(27/47)低级别黏膜内瘤变 NBI 阳性,其中85.2%(23/27)NBI 分级为Ⅱ、Ⅲ级。(4)93.6%(44/47)高级别黏膜内瘤变IPCL 形态异常,其中88.6%(39/44)IPCL 分型为Ⅳ、Ⅴ型;76.6%(36/47)低级别黏膜内瘤变 IPCL 形态异常,其中77.8%(28/36)IPCL 分型为Ⅱ、Ⅲ型。结论与白光模式相比,NBI 模式与碘染色均可增强病变的识别性,提高内镜医师对病变的检出率。NBI 结合放大内镜可提高对高级别黏膜内瘤变诊断的符合率,效果与碘染色相当。NBI 在早期食管癌及癌前病变诊断有一定的临床应用价值。Objective To evaluate the narrow-banding imaging （NBI） in the diagnosis of early esophageal squamous cancer and precancerous lesions. Methods The esophagus was examined with white-light and NBI endoscopy respectively. Subsequently, abnormal appearance of intrapapillary capillary loop （IPCL） was carefully inspected by NBI combined with magnifying endoscopy. Finally, 1.2% Lugoul＇s iodine solution was used to stain the mucosal surface. For each suspected lesion, the location, classification and technique used were recorded. Biopsies were taken from each abnormal part. The pathologic diagnosis was considered as golden standard for all lesions, thus the grade of NBI, the type of IPCL and the grade of Lugoul＇s iodine staining in lesions were compared with pathologic features. Results （ 1 ） One hundred and four lesions were detected in 72 patients with all techniques above. With white-light endoscopy, the incidence rate of early esophageal squamous cancer and precancerous lesions detected by senior endoscopist and junior endoscopist was 82.7% （86/104） and 70. 2% （73/107）, respectively. With NBI endoscopy and iodine staining, the incidence rate detected by senior or junior endoscopists was the same, 86. 5% （90/104） and 100. 0%, respectively. （2） For iodine staining, 100% of high grade intraepithelial neoplasia（HGIN） were positive, including 83.0% （39/47） Grade Ⅰ, and 17.0% （ 8/47 ） Grade Ⅱ / Ⅲ. 100% of low grade intraepithelial neoplasia （ LGIN ） were positive, including 12. 8% （ 6/47 ） Grade Ⅰ and 87. 2% （ 41/47 ） Grade Ⅱ/Ⅲ. （3）Using NBI, 91.5% （43/47）of HGIN were positive, including 69. 8% （30/43） Grade Ⅰ and 30. 2% （ 13/43 ） Grade Ⅱ / Ⅲ. 57.4% （ 27/47 ） of LGIN were positive, including 14. 8% （ 4/27 ） Grade Ⅰ and 85. 2% （23/27） Grade Ⅱ/Ⅲ. （4） In appearance of IPCL, 93. 6% （44/47） of HGIN were abnormal, including 88. 6% （39/44） Type Ⅳ/Ⅴ and 11.4% （ 5/44 ） Type Ⅱ / Ⅲ. 76.6% （ 36/47 ） of

关 键 词：食管肿瘤 内窥镜检查 消化系统 窄带成像技术 毛细血管 

分 类 号：R735.1[医药卫生—肿瘤]