四种增强放大内镜在早期胃癌及癌前病变筛查中诊断价值的前瞻性多中心研究  

A multicenter prospective evaluation of four enhanced magnifying endoscopy for diagnosis of precancerous lesions and early gastric cancers

作　　者：于航[1] 杨爱明[1] 陆星华[1] 周炜洵[2] 郭涛[1] 舒慧君[1] 姚礼庆[3] 何利平[4] 王邦茂[5] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化内科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院病理科 [3]复旦大学附属中山医院内镜诊疗研究所 [4]福建省立医院消化内镜科 [5]天津医科大学总医院消化内科

出　　处：《中华消化内镜杂志》2015年第7期421-426,共6页Chinese Journal of Digestive Endoscopy

基　　金：卫生行业公益专项“癌症靶向治疗、细胞治疗规范化及早诊早治应用研究”资助（200902002）

摘　　要：目的评价肾上腺素增强的放大内镜（ME—EPI）、冰醋酸-靛胭脂增强的放大内镜（ME—AIM）、靛胭脂增强的放大内镜（ME-IDC）和窄带成像增强的放大内镜（ME-NBI）对早期胃癌的诊断价值。方法2010年1月至2011年12月，将在4家医疗中心通过普通白光内镜（WLE）筛查出的3059名患者（3097处局灶性胃黏膜病变）分为3组，分别进行ME-EPI（1094处病变）、ME—AIM（873处病变）、ME-IDC（1130处病变）检查，内镜评估依据VS诊断标准，以活检组织的病理诊断为金标准，评价不同色素放大内镜对早期胃癌诊断的准确性。同时，对每组色素放大内镜患者分别进行配对的ME-NBI观察，评价每种色素放大内镜与ME-NBI对早期胃癌诊断的准确性。结果在3059名患者的3097处病变中，有205处病变经活检组织病理诊断为早期胃癌。ME-EPI、ME—AIM、ME—IDC对早期胃癌诊断的准确性分别为98．2％、99．0％、98．4％，在各组中，配对的ME—NBI诊断早期胃癌的准确性分别为98．0％、99．0％、97．4％。与ME．NBI相比，ME-EPI和ME—AIM对早期胃癌诊断的准确性升高或持平，差异没有统计学意义（P〉0．05），而ME—IDC诊断的准确性升高，差异有统计学意义（P〈0．05）。结论色素放大内镜是一种准确、简便、安全、价格低廉的早期胃癌诊断方法，ME—NBI的诊断效率并不优于色素放大内镜。Objective To evaluate the diagnostic accuracy of four enhanced magnifying endoscopy methods for precancerous lesions and early gastric cancers, i. e. , magnifying endoscopy enhanced by epinephrine（ME-EPI）, magnifying endoscopy enhanced by acetic acid-indigo carmine mixture （ME-AIM）, magnifying endoscopy enhanced by indigo carmine（ME-IDC） and magnifying endoscopy enhanced with narrow-band imaging（ME-NBI）. Methods A total of 3 059 patients （3 097 focal gastric lesions ） detected with conventional white light endoscopy（WLE） at four hospitals from January 2010 to December 2011 were recruited and divided into three groups according to different chromoendoscopic procedures they underwent： 1 094 ME-EPI cases, 873 ME-AIM cases and 1 130 ME-IDC cases. The pathological results were used as golden standard, and diagnosis accuracy rates of precancerous lesions or early cancers were determined according to the VS criteria. At the mean time, in each group, a paired design was used to compare the accuracy between the above chromoendoscopies and ME-NBI respectively. Results A total of 3 097 lesions of 3 059 patients were evaluated, and 205 lesions were diagnosed as early gastric cancer according to pathologi- cal results. The diagnostic accuracy rates of ME-EPI, ME-AIM and ME-IDC for early gastric cancer were 98.2%, 99. 0% and 98.4%, respectively. In each group, the diagnostic accuracy rates of paired ME-NBI were 98. 0%, 99.0% and 97.4%, respectively. In contrast to ME-NBI, the diagnostic accuracy of ME-EPI and ME-AIM were comparable or lower, but the differences were not statistically significant （ P 〉 0. 05 ）. However, when it came to ME-IDC, the diagnostic accuracy declined and the differences were statistically significant （P 〈 0. 05）. Conclusion Chromoendoscopy can be used to identify the early gastric cancer accurately, easily, safely and inexpensively. And the diagnostic effectiveness of ME-NBI is not superior to chromoendoscopy in diagnosing early gastric cancer.

关 键 词：早期胃癌 诊断 色素放大内镜 窄带成像技术 

分 类 号：R735.2[医药卫生—肿瘤]