共聚焦激光显微内镜与胃黏膜活检诊断早期胃癌及其癌前病变的对比研究  

Comparison between confocal laser endomicroscopy and gastric biopsy for diagnosis of early gastric cancer and precancerous disease

作　　者：范晓飞[1] 薛寒冰[1] 赵韫嘉[1] 李晓波[1] 戴军[1] 陈晓宇[1] 高云杰[1] 戈之铮[1] 陈海英[1] 萧树东[1] 

机构地区：[1]上海交通大学医学院附属仁济医院消化内科上海市消化疾病研究所,上海200001

出　　处：《中华消化内镜杂志》2013年第7期365-368,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的比较共聚焦激光显微内镜（CLE）和胃黏膜活检对早期胃癌及癌前病变的诊断价值。方法46例常规内镜诊断为可疑早期胃癌的患者首先行CLE检查，然后改常规白光内镜于病变最明显处取活检2块。将CLE诊断和胃黏膜活检诊断与内镜下切除术后或手术后最终病理结果进行对比，一致性采用Kappa检验，并计算CLE诊断癌性病变的灵敏度、特异度、阳性预测值、阴性预测值和准确率。结果最终病理诊断炎症1例、低级别上皮内瘤变4例、高级别上皮内瘤变10例、分化型腺癌28例和未分化型癌3例。CLE与最终病理诊断结果一致者38例（82．6％，38／46），两者一致性检验Kappa值为0．720；胃黏膜活检与最终病理诊断结果一致者28例（60．9％，28／46），两者一致性检验Kappa值为0．437。CLE对癌性病变诊断的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为97．6％（40／41）、80．0％（4／5）、97．6％（40／41）、80．0％（4／5）和95．7％（44／46）。结论CLE对早期胃癌及其癌前病变具有较高的诊断价值，与病理组织学一致性高。Objective To compare the diagnositie values of confocal laser endomicroscopy （CLE） and gastric biopsy. Methods A total of 46 patients with suspicious early gastric cancer diagnosed by eonv-ential gastroscopy underwent CLE. Fluorescein sodium was intravenously injected, and suspicious lesions were observed and CLE pictures were saved. Random biopsy specimen was taken from the suspicious lesions for histopathological examination and the result of CLE and gastric biopsy was compared according to final histopathologieal finding. Kappa test was used to determine the consistency, and the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accurate rate were then calculated. Results Of the 46 patients with suspicious early gastric cancer, 36 patients underwent endoscopic submueo-sal dissection （ESD） and other 10 patients underwent surgery. The Kappa value of CIE and post-ESD and surgery histopothological examination was 0. 720. The Kappa value of gastric biopsy and post-ESD and surgery histopothologieal examination was 0. 437. The sensitivity, specificity, the positive predictive value, the neg-ative predictive value and the diagnostic accurate value of CLE in diagnosis of gastric neoplasia were 97.6% , 80. 0%, 97.6% , 80. 0% and 95.7%. Conclusion CLE is significant value for diagnosis of early gastric cancer and precancerous disease with a high consistency with histopathology.

关 键 词：胃肿瘤 活组织检查 共聚焦激光显微内镜 诊断 

分 类 号：R735.2[医药卫生—肿瘤]