窄带成像放大内镜联合超声小探头在早期胃癌及癌前病变诊疗中的价值  

The value of NBI-ME combined with ultrasound miniprobe in the diagnosis of early gastric cancer and precancerous lesions

作　　者：杨梅 原丽莉 YANG Mei;YUAN Lili(Department of Gastroenterology,Shanxi Bethune Hospital,The Third Hospital of Shanxi Medical University,Taiyuan,Shanxi 030032,China)

机构地区：[1]山西白求恩医院、山西医科大学第三医院消化内科,山西太原030032

出　　处：《安徽医药》2023年第12期2494-2497,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨窄带成像放大内镜(NBI-ME)联合超声小探头在早期胃癌(EGC)或癌前病变中的诊疗价值。方法收集山西白求恩医院2015年1月至2020年12月收治的行内镜下黏膜剥离术(ESD)且术后病理证实为癌前病变或EGC的88例病人的临床资料。以ESD术后获得的标本组织病理学诊断结果为金标准,判断NBI-ME和超声内镜(EUS)检查的准确性、灵敏度及特异度;同时分析NBI-ME的判断结果、超声小探头对病变浸润深度的判断结果及NBI-ME靶向活检结果与ESD术后病理学结果的一致性,并计算Kappa值及总准确率。结果NBI-ME诊断EGC的灵敏度为78.79%、特异度为90.91%,总准确率高达86.36%,与术后病理结果比较一致性较好(P<0.05,Kappa=0.706);NBI-ME靶向活检病理诊断与术后病理诊断结果一致的共77例,总准确率为87.5%,与术后病理结果比较一致性较好(P<0.05,Kappa=0.755);EUS预判结果与术后病理结果一致的共79例,总准确率高达89.77%,与术后病理结果比较一致性较好(P<0.05,Kappa=0.611)。结论NBI-ME能清晰地显示病变黏膜的表面微结构和微血管结构,提高了EGC及癌前病变的检出率,结合超声小探头能较好地判断浸润深度,为病人选择最佳治疗方案,改善病人预后及远期生存质量。Objective To explore the value of narrow-band imaging magnifying endoscopy(NBI-ME)combined with ultrasound miniprobe in the diagnosis and treatment of early gastric cancer(EGC)or precancerous lesions.Methods The clinical data of 88 patients,who underwent endoscopic submucosal dissection(ESD)were pathologically confirmed to be precancerous lesions or EGCs in Shanxi Bethune Hospital from January 2015 to December 2020,were enrolled in the study.The histopathological diagnosis results obtained after ESD were used as the gold standard to judge the accuracy,sensitivity and specificity of NBI-ME and endoscopic ultrasonography(EUS).The consistency of the pathological results after ESD with the results of NBI-ME,the depth of invasion detected by the ultrasound microprobe,and NBI-ME targeted biopsy were also analyzed separately.The Kappa values and overall accuracy were calculated.Results The sensitivity and specificity of NBI-ME in the diagnosis of EGC were 78.79% and 90.91%,and the overall accuracy was as high as 86.36%,which was in good agreement with the postoperative pathological results(P<0.05,Kappa=0.706).There were 77 cases in which the NBI-ME targeted biopsy diagnosis was consistent with the postoperative pathological diagnosis,and the total accuracy rate was 87.5%,which was in good agreement with the postoperative pathological results(P<0.05,Kappa=0.755).There were 79 cases in which the EUS prediction results were consistent with the postoperative pathological results,and the total accuracy rate was as high as 89.77%,which was in good agreement with the postoperative pathological results(P<0.05,Kappa=0.611).Conclusions NBI-ME can clearly display the surface microstructure and microvascular structure of the diseased mucosa,which improves the detection rate of EGC and precancerous lesions.In combination with the ultrasonic miniprobe,it can better judge the depth of invasion,select the optimal therapeutic regimen for patients,and improve the patient prognosis and long-term survival.

关 键 词：胃肿瘤 癌前病变 窄带成像放大内镜 超声内镜 超声小探头 癌症早期检测 

分 类 号：R735.2[医药卫生—肿瘤]