窄带成像技术联合放大内镜与胃镜活检诊断早期胃癌的价值比较  

Comparison between narrowband imaging combined with magnifying endoscopy and gastric biopsy for diagnosis of early gastric cancer

作　　者：郑洪伟[1] 薛会光[1] 杨爱华[2] 刘华[1] 鞠辉[1] 刘希双[1] 

机构地区：[1]青岛大学附属医院消化内科,山东省青岛市266100 [2]青岛大学附属医院检验科,山东省青岛市266100

出　　处：《世界华人消化杂志》2015年第24期3917-3922,共6页World Chinese Journal of Digestology

摘　　要：目的:评估比较窄带成像技术联合放大内镜(narrow band imaging-magnifying endoscopy N B I-M E)、内镜病理活检在早期胃癌诊断中的价值.方法:首先在普通白光下系统观察,发现可疑病变(胃黏膜形态或颜色改变)后行NBIME观察,采集照片并做出内镜下诊断,于病灶最明显处取活检并行病理检查.所有患者均行内镜下切除或外科手术治疗,术后行病理活检.分别计算NBI-ME、内镜活检诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率.比较内镜活检与术后切除病理的一致性,并计算Kappa值.结果:123例纳入本研究,最终术后切除病理示胃炎51例,低级别上皮内瘤变(low-grade neoplasia,LGIN)24例,早期胃癌48例.NBIM E诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为97.9%、80.0%、75.8%、98.4%、87.0%,内镜活检的对应值分别为66.7%、94.7%、88.9%、81.6%、83.7%.NBI-ME诊断早期胃癌的敏感度明显高于内镜活检(P<0.005),特异度低于内镜活检(P<0.005),两者准确率无明显差异(P>0.05).内镜下活检病理与术后切除病理Kappa值为0.642(P<0.05).结论:NBI-ME对早期胃癌诊断价值较高,对于NBI-ME下符合早期胃癌诊断的患者建议行内镜或手术进一步治疗.AIM：To evaluate the diagnostic performance of narrow-band imaging combined with magnifying endoscopy（NBI-ME） for early gastric cancer by comparing with gastric biopsy.METHODS：Patients with suspicious early gastric lesions（including abnormal mucosal morphology and abnormal mucosal color） as revealed by white light endoscopy（WLE） were enrolled in the study.These suspicious lesions were examined by NBI-ME to give a diagnosis.Biopsy specimens were then taken from suspicious lesions for pathological examination.All patients received endoscopic resection or surgical intervention.The diagnostic performance of the two modalities was compared.RESULTS：A total of 123 patients were enrolled,including 76 men and 47 women.The final pathology showed 51 cases of gastritis,24 cases of low grade intraepithelial neoplasia,and 48 cases of early gastric cancer.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of NBI-ME for diagnosing early gastric cancer were 97.9%,80.0%,75.8%,98.4%,and 87.0%,respectively;the corresponding percentages for endoscopic biopsy were 66.7%,94.7%,88.9%,81.6%,and83.7%,respectively.The sensitivity of NBI-ME was significantly better than that of endoscopic biopsy（P 〈0.005）,but specificity was lower than that of endoscopic biopsy（P〈 0.005）.There was no statistical difference in diagnostic accuracy between the two modalities.The Kappa value for the two modalities was 0.642（P 〈0.05）.CONCLUSION：NBI-ME can improve the diagnosis of early gastric cancer.When early gastric cancer is diagnosed by NBI-ME,further intervention treatment is required.

关 键 词：早期胃癌 窄带成像技术 放大内镜 病理 诊断 

分 类 号：R735.2[医药卫生—肿瘤]