窄带成像放大内镜指导靶向活检对早期食管癌诊断的临床价值  

Clinical value of magnifying endoscopy-narrow band imaging in diagnosis of early esophageal cancer

作　　者：苏振华[1] 王亮[1] 魏思忱[1] 魏新亮[1] Zhen-hua Su;Liang Wang;Si-chen Wei;Xin-liang Wei(Department of Gastroenterlolgy,Cangzhou Central Hospital,Cangzhou,Hebei 061000,China)

机构地区：[1]河北省沧州市中心医院消化内科,河北沧州061000

出　　处：《中国内镜杂志》2019年第1期16-21,共6页China Journal of Endoscopy

基　　金：河北省沧州市科技项目(No:151302139)

摘　　要：目的评估窄带成像放大内镜(ME-NBI)在早期食管癌诊断中指导靶向活检的临床价值。方法将2015年10月-2017年12月经普通白光内镜(C-WLI)检查发现食管黏膜早期病变并取得病理的患者纳入研究,进一步行ME-NBI精查并指导靶向活检,有一次病理诊断阳性者即行内镜下治疗。以内镜下切除后病理结果为金标准,比较两种内镜指导病理的诊断准确度。结果 (1)研究共纳入91例患者,其中4例术前病理均为黏膜炎症,未行内镜下治疗,余87例均行内镜下切除,C-WLI指导病理、ME-NBI靶向病理与术后病理比较,总体符合率由18.39%(16/87)提高为88.50%(77/87),差异有统计学意义(P<0.05);(2)对早期食管癌和高级别上皮内瘤变(HGIN)的诊断,ME-NBI靶向病理与C-WLI指导病理的灵敏度分别为92.18%和33.33%,准确度分别为91.67%和60.86%,差异均有统计学意义(P<0.05);(3) ME-NBI通过观察毛细血管袢(IPCL)变化可以评价病变浸润深度,对术前评估起到指导性作用。结论对于早期食管癌的诊断,ME-NBI指导靶向病理结果明显优于C-WLI指导病理,故ME-NBI内镜可作为早期食管病变精查和评价病变浸润深度的检查方法。Objective To evaluate the clinical value of magnifying endoscopy-narrow band imaging(ME-NBI)for targeting biopsy of lesions in the early esophageal cancer.Methods 91 patients with suspicious early esophageal lesions under common white light imaging(C-WLI)were prospcetively entrolled and biopsied from October 2015 to December 2017.Further endoscopy was conducted using ME-NBI and target biopsy.87 patients receved endoscopic resection(ER).Outcomes of WLI biopsy and ME-NBI target biopsy,with histology of ER specimen as golden standard.Results The overall diagnostic accuracy of C-WLI biopsy and target biopsy were increased from 18.39%(16/87)to 88.50%(77/87),with statistically significant difference(P<0.05);In diagnosing early esophageal cancer and high-grade intraepithelial neoplasia,the sensitivity of ME-NBI targeted biopsy and C-WLI biopsy were 92.18%and 33.33%,The accuracy were 91.67%and 60.86%,respectively.All the differences were statistically significant(P<0.05);ME-NBI can evaluate the infiltration depth of lesions by observing the changes of IPCL,playing a guiding role in preoperative evaluation.Conclusion In the diagnosis of early esophageal cancer,ME-NBI targeted biopsy is superior to the C-WLI biopsy,ME-NBI can be used in checking infiltration depth inspection of early esophageal cancer.

关 键 词：早期食管癌 窄带成像 放大内镜 高级别上皮内瘤变 低级别上皮内瘤变 

分 类 号：R735.1[医药卫生—肿瘤]