窄带成像技术联合苯胺蓝染色在鼻咽癌内镜诊断中的价值  

Value of narrow band imaging combined with aniline blue staining in endoscopic diagnosis of nasopharyngeal carcinoma

作　　者：薛晓成[1] 申学良 陈晓平[1] 滕伟强 黄水仙 张燚[1] 周恩晖 鲁丹 张翘楚 张雪[5] XUE Xiao-cheng;SHEN Xue-liang;CHEN Xiao-ping;TENG Wei-qiang;HUANG Shui-xian;ZHANG Yi;ZHOU En-hui;LU Dan;ZHANG Qiao-chu;ZHANG Xue(Department of Otorhinolaryngology Head and Neck Surgery,Gongli Hospital,Naval Medical University(Second Military Medical University),Shanghai 200135,China;Department of Otorhinolaryngology Head and Neck Surgery,The First People’s Hospital of Yinchuan,Yinchuan 750001,Ningxia Hui Autonomous Region,China;Department of Otorhinolaryngology Head and Neck Surgery,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China;Department of Pathology,Gongli Hospital,Naval Medical University(Second Military Medical University),Shanghai 200135,China;Key Laboratory of Artificial Intelligence for Inflammation and Chronic Disease Management,Shanghai Municipal Health Commission,Gongli Hospital,Naval Medical University(Second Military Medical University),Shanghai 200135,China)

机构地区：[1]海军军医大学(第二军医大学)附属公利医院耳鼻咽喉头颈外科,上海200135 [2]银川市第一人民医院耳鼻咽喉头颈外科,银川750001 [3]海军军医大学(第二军医大学)第一附属医院耳鼻咽喉头颈外科,上海200433 [4]海军军医大学(第二军医大学)附属公利医院病理科,上海200135 [5]海军军医大学(第二军医大学)附属公利医院、上海市卫生健康委员会炎症与慢病管理人工智能重点实验室,上海200135

出　　处：《海军军医大学学报》2023年第6期754-758,共5页Academic Journal of Naval Medical University

基　　金：上海市卫生健康委员会青年项目(20204Y0144);上海市浦东新区卫生系统优秀青年医学人才培养计划(PWRq2020-63,PWRq2020-61);上海市卫生系统重点专科建设资助项目(ZK2019C06);上海市浦东新区临床特色专科项目(PWYts2021-15)。

摘　　要：目的探讨窄带成像技术(NBI)联合苯胺蓝染色在鼻咽癌内镜筛查及诊断中的价值。方法选择2017年10月至2021年10月在海军军医大学(第二军医大学)附属公利医院和银川市第一人民医院就诊且怀疑有鼻咽部占位性病变的68例患者,使用具有NBI模式的电子鼻咽镜进行鼻咽部检查,取疑似病变表面的渗液进行苯胺蓝染色,并对疑似病变进行病理活检。以病理检查结果作为诊断金标准,分别计算白光模式、NBI模式、苯胺蓝染色及NBI联合苯胺蓝染色4种检查手段的灵敏度、特异度、阳性预测值、阴性预测值和准确度及Kappa系数,并使用χ^(2)检验比较各检查方法的诊断阳性率。结果NBI与苯胺蓝染色联合诊断鼻咽癌的阳性率高于白光内镜、NBI、苯胺蓝染色单独诊断[97.83%(45/46)vs 56.52%(26/46)、84.78%(39/46)、80.43%(37/46)],差异均有统计学意义(P均<0.001)。NBI联合苯胺蓝染色诊断鼻咽癌的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为97.83%、86.36%、93.75%、95.00%和94.12%。NBI联合苯胺蓝染色对鼻咽癌的诊断结果与病理检查结果有较好的一致性(Kappa系数为0.862)。结论相较于白光模式及单一NBI模式和苯胺蓝染色,NBI联合苯胺蓝染色对鼻咽癌有较高的灵敏度和特异度。Objective To explore the value of narrow band imaging(NBI)combined with aniline blue staining in endoscopic screening and diagnosis of nasopharyngeal carcinoma.Methods From Oct.2017 to Oct.2021,68 patients with suspected nasopharyngeal space-occupying lesions were selected from Gongli Hospital of Naval Medical University(Second Military Medical University)and The First People’s Hospital of Yinchuan.Electronic nasopharyngoscope with NBI was used for nasopharyngeal examination.Meanwhile,the effusion on the surface of the suspected lesions was stained with aniline blue,and the suspected lesions were examined by pathological biopsy.With the pathological results as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Kappa value of white light mode,NBI,aniline blue staining and NBI combined with aniline blue staining were calculated,andχ^(2)test was used to compare the diagnostic positive rates of the above 4 examination methods.Results The positive rate of the combined diagnosis was significantly higher than those of white light endoscopy,NBI and aniline blue staining alone(97.83%[45/46]vs 56.52%[26/46],84.78%[39/46],and 80.43%[37/46],all P<0.001).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of NBI combined with aniline blue staining for nasopharyngeal carcinoma were 97.83%,86.36%,93.75%,95.00%and 94.12%,respectively.The diagnostic results of NBI combined with aniline blue staining for nasopharyngeal carcinoma were in good consistency with the pathological findings(Kappa value was 0.862).Conclusion Compared with white light mode,NBI or aniline blue staining alone,NBI combined with aniline blue staining has higher sensitivity and specificity for the diagnosis of nasopharyngeal carcinoma.

关 键 词：鼻咽肿瘤 窄带成像技术 苯胺蓝染色 早期诊断 鼻咽镜检查 

分 类 号：R739.63[医药卫生—肿瘤]