窄带成像技术在复发鼻咽癌中的诊断价值  

Diagnostic value of narrow-band imaging in detection of recurrent nasopharyngeal carcinoma

作　　者：司晋源 翁敬锦[1] 张本坚[1] 兰桂萍[1] 杨涌[1] 黄波[1] 王勇利[1] 覃颖[1] 李冰[1] 韩星[1] 熊伟明[1] 司勇锋[1] Si Jinyuan;Weng Jingjin;Zhang Benjian;Lan Guiping;Yang Yong;Huang Bo;Wang Yongli;Qin Ying;Li Bing;Han Xing;Xiong Weiming;Si Yongfeng(Department of Otorhinolaryngology Head and Neck Oncology, People＇s Hospital of Guangxi Zhuang Autonomous Region,530021 Nanning, China)

机构地区：[1]广西壮族自治区人民医院耳鼻咽喉头颈肿瘤科,南宁530021

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第12期895-899,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广西科学研究与技术开发计划（1355005-3-9、14124003-1-3）

摘　　要：目的 探索窄带成像（narrow band imaging,NBI）技术在鼻咽癌复发中的诊断价值及可行性.方法 对广西壮族自治区人民医院耳鼻咽喉头颈肿瘤科2013年1月1日至2015年12月31日初程治疗结束后肿瘤完全消退的1 364例鼻咽癌患者进行治疗后的复查.复查项目：鼻咽颅底MRI、胸片X线、腹部B超、EB病毒血清学检查、内镜检查（白光及NBI模式）及鼻咽部活组织检查.高清电子鼻咽镜检查中白光模式或NBI模式下阳性者均对镜检可疑部位取鼻咽部病理活检;以鼻咽部活检结果作为诊断的金标准,分别计算两种模式镜检的敏感性、特异性、诊断符合率（diagnose accordance rate,DAR）及约登指数（Yonden＇s index）,并使用X2检验进行对比;计算两种模式镜检查的Kappa指数,了解两种模式内镜检查结果与病理活检结果的一致性.计算已确诊的复发早期患者（Ⅰ期＋Ⅱ期）中NBI模式下及白光模式下镜检阳性例数及阳性率.结果 白光模式镜检阳性265例,病理确诊鼻咽癌68例;NBI模式镜检阳性82例,病理确诊鼻咽癌74例.白光模式敏感度为91.89％,特异度为0,诊断符合率为25.09％,约登指数为-0.081 1,白光模式对鼻咽癌高危人群的诊断与活检病理结果的一致性差（Kappa系数=-0.045）;NBI模式敏感度为100.00％,特异度为95.94％,诊断符合率为97.05％,约登指数为0.9594,NBI对鼻咽癌高危人群的诊断与活检病理结果的一致性极好（Kappa系数=0.928）.复发早期患者31例,白光及NBI模式内镜检查阳性率分别为80.65％和100.00％,差异有统计学意义,P=0.024.结论 NBI模式内镜检查相对于白光模式内镜检查具有更高的敏感度、特异度、诊断符合率及约登指数.且早期诊断率明显高于白光模式内镜.Objective To evaluate the diagnostic value and feasibility of narrow-band imaging in detection of recurrent nasopharyngeal carcinoma （NPC）.Methods One thousand three hundred and sixty-four NPC patients who had completed NPC treatment were enrolled.All patients were followed-up with imaging,serological examination of EB virus and nasopharyngeal endoscopy（WL and NBI mode）,in which （1） both white light （WL） and NBI modes were done;（2） positive endoscopic patients were given nasopharyngeal biopsy;（3） using histologic finding as criterion standard,the sensitivity,specificity,accuracy and Yonden＇s index of two modes were compared.Kappa index was used to evaluate the consistency between the two modes and pathological results respectively;（4） the positive rates of WL and NBI in patients with early recurrent （stage Ⅰ ＋ Ⅱ） were compared,Results A total of 265 cases were suspected as having recurrent lesions by endoscopy in WL mode and 68 cases of them were pathologically diagnosed as having NPC;and 82 cases were suspected as having recurrent lesions by endoscopy in NBI mode and 74 cases of them were pathologically diagnosed as having NPC.The sensitivity,specificity,accuracy and Yonden＇s index of WL mode were 91.89%,0,25.09% and-0.0811,respectively,with a kappa of-0.045;the sensitivity,specificity,accuracy and Yonden＇s index of NBI mode were 100.00%,95.94%,97.05% and 0.9594,respectively.Conclusion NBI has higher sensitivity,specificity,early diagnosis rate and Yonden＇s index than WL.

关 键 词：鼻咽肿瘤 动态镜检查 复发 

分 类 号：R739.63[医药卫生—肿瘤]