醋酸染色联合内镜窄带成像技术在咽部、会厌部乳头状瘤诊断中的价值  

Value of Acetic Acid Staining Combined with Narrow Band Imaging in Diagnosis of Pharyngeal and Epiglottic Papilloma

作　　者：杨文飞[1] 王睿卿 彭韶平[1] 邓冬明 YANG Wen-fei;WANG Rui-qing;PENG Shao-ping;DENG Dong-ming(Department of Otolaryngology and Head and Neck Surgery,the First Affiliated Hospital of Gannan Medical College,Ganzhou 341000,China)

机构地区：[1]赣南医学院第一附属医院耳鼻咽喉头颈外科,江西赣州341000

出　　处：《实用临床医学（江西）》2023年第5期35-39,F0004,共6页Practical Clinical Medicine

摘　　要：目的探讨醋酸染色联合内镜窄带成像技术(NBI)对咽部、会厌部乳头状瘤的诊断价值。方法收集2020年1月至2022年1月在赣南医学院第一附属医院行电子鼻咽喉镜检查发现的疑似咽部、会厌部乳头状瘤患者57例,以病理诊断结果为金标准,比较普通白光内镜(WLE)、NBI内镜、醋酸染色联合NBI内镜(AA-NBI)3种模式下的诊断效能(灵敏度、特异度、Kappa一致性)。结果WLE模式诊断准确率为63.16%,NBI模式为84.21%,AA-NBI模式为91.23%,AA-NBI模式诊断准确率显著高于WLE模式、NBI模式(P<0.05)。ROC曲线分析显示,WLE模式诊断乳头状瘤的灵敏度为66.67%、特异度为50.00%、曲线下面积(AUC)为0.583,NBI模式分别为86.67%、75.00%、0.808,AA-NBI模式分别为93.33%、83.33%、0.883,AA-NBI模式灵敏度显著高于NBI模式和WLE模式(P<0.05),3种模式特异度比较差异无统计学意义(P>0.05)。Kappa一致性分析结果显示,WLE模式、NBI模式、AA-NBI模式的Kappa值分别为0.131、0.565、0.744,WLE模式与病理诊断结果的一致性差,NBI模式一致性中等,AA-NBI模式一致性较好。结论醋酸染色是一种安全、便宜的色素染料,醋酸染色联合NBI内镜可以清晰地显示乳头状瘤病变形态,与单纯NBI、WLE比较均具有较高的准确性,是一种诊断咽部、会厌部乳头状瘤安全、有效的方法。Objective To explore the value of acetic acid staining combined with narrow band imaging(NBI)in the diagnosis of pharyngealand epiglottic papilloma.Methods A total of 57 patients with suspected pharyngeal and epiglottic papilloma detected by electronic nasopharyngoscopy in the First Affiliated Hospital of Gannan Medical College from January 2020 to January 2022 were included in the study.Using pathological diagnosis as the gold standard,the diagnostic efficiencies(sensitivity,specificity and Kappa consistency)of general white light endoscopy(WLE),NBI and acetic acid staining combined with NBI(AA-NBI)were compared.Results The diagnostic accuracy of WLE,NBI and AA-NBI were 63.16%,84.21%and 91.23%,respectively.The diagnostic accuracy of AA-NBI was significantly higher than that of WLE and NBI(P<0.05).The sensitivity,specificity and AUC for diagnosing papilloma were,respectively,66.67%,50.00%and 0.583 for WLE,86.67%,75.00%and 0.808 for NBI,and 93.33%,83.33%and 0.883 for AA-NBI.The sensitivity of AA-NBI is higher than that of NBI or WLE(P<0.05).There was no significant difference in the specificity among the three modes(P>0.05).The Kappa values of WLE,NBI and AA-NBI were 0.131,0.565 and 0.744,respectively.WLE,NBI and AA-NBI showed poor,moderate and good consistency with the pathological results,respectively.Conclusion Acetic acid is a safe and cheap pigment dye.The combination of acetic acid staining and NBI can clearly display the pathological morphology of papilloma,and has higher accuracy than NBI or WLE alone.Therefore,acetic acid staining combined with NBI a safe and effective method for the diagnosis of pharyngeal and epiglottic papilloma.

关 键 词：乳头状瘤 咽部 会厌部 醋酸染色 窄带成像技术 

分 类 号：R443.8[医药卫生—诊断学] R739.6[医药卫生—临床医学]