内镜检查对声带白斑病理诊断的预测价值研究  

Predictive value of endoscopic examination for pathological diagnosis of vocal cord leukoplakia

作　　者：王也煜 常玮[2] 李军[2] WANG Yeyu;CHANG Wei;LI Jun(Department of Pathology,Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046000,Shanxi,China;Department of Otolaryngology,Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046000,Shanxi,China)

机构地区：[1]长治医学院附属和平医院病理科,山西长治046000 [2]长治医学院附属和平医院耳鼻咽喉科,山西长治046000

出　　处：《中国现代医生》2024年第29期50-53,61,共5页China Modern Doctor

基　　金：长治医学院博士科研启动基金项目(BS202124)。

摘　　要：目的旨在确定内镜下白光成像(white lighting imaging,WLI)和窄带成像(narrow band imaging,NBI)对声带白斑(vocal cord leukoplakia,VCL)病理类型进行诊断的最佳截断点,以提高非侵入性预测VCL病理性质的准确性,并为VCL患者是否需要手术干预及手术时机提供参考依据。方法纳入96例确诊病理性质为VCL患者。术前分别进行WLI模式及NBI模式下的图像采集,并对病变进行WLI模式Chen分型和NBI模式Ni分型的评定。通过比较受试者操作特征曲线的约登指数得出分型的最佳截断值。通过比较2种临床分型的曲线下面积(area under the curve,AUC)、最佳截断值下的准确度、敏感度、特异性、阳性预测值及阴性预测值评价不同临床分型对VCL病理性质的诊断效能。结果WLI模式Chen分型、NBI模式Ni分型与病理等级间均存在相关性(rs=0.513、0.653,P<0.001)。WLI模式Chen分型的最佳截断值为3,即光滑平坦型及光滑隆起型为良性病变,粗糙型为恶性病变;NBI模式Ni分型的最佳截断值为5,即Ⅰ~Ⅳ型为良性病变,Ⅴ型、Ⅵ型为恶性病变。WLI模式Chen分型、NBI模式Ni分型的AUC分别为0.815,0.875。最佳截断值的准确度、敏感度、特异性、阳性预测值及阴性预测值Chen分型为79.51%,84.62%,75.71%,72.13%,86.89%;Ni分型为85.25%,76.92%,91.42%,86.96%,84.21%。结论NBI模式Ni分型及WLI模式Chen分型的诊断效能均较高,但NBI模式Ni分型对VCL病理性质的诊断效能高于白光模式Chen分型。Objective To select the most accurate classification in white light imaging(WLI)and narrow band imaging(NBI)for diagnosing the pathological result of vocal cord leukoplakia(VCL)and the proposed cut-off point,which can improve the accuracy of non-invasive prediction of the pathological result of VCL and can provide basis for whether the VCL patients need surgery and the timing of surgical intervention.Methods Ninty six VCL patients were included in the study.Before surgery,images were collected in WLI and NBI respectively.According to Chen classification in WLI and Ni classification in NBI,lesions were evaluated.By comparing Youden’s index,the proposed cut-off point for classification more than two degrees can be assessed.By comparing the area under curve(AUC),accuracy,sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of four clinical classifications per the purposed cut-off point,the diagnostic performance of different clinical classifications on the pathological results of VCL was assessed,the most accurate classification and the purposed cut-off point were obtained.Results There was a correlation between Chen classification WLI light mode and Ni classification in NBI mode with pathological grade(rs=0.513,0.653,P<0.001).In WLI,the purposed cut-off point of Chen classification is 3(flat and smooth type is bengin,elecated and smooth type and rough type are maligant);in NBI,the purposed cut-off point of Ni classification is 5(Ⅰ-Ⅳtype were bengin,ⅤandⅥtype were maligant).The AUC of two clinical classifications’model were 0.815,0.875.The accuracy,sensitivity,specificity,PPV and NPV of the Chen classifications(purposed cut-off point)were 79.51%,84.62%,75.71%,72.13%,86.89%,Those of Ni classification were 85.25%,76.92%,91.42%,86.96%,84.21%.Conclusions:Ni classification in NBI and Chen classification in WLI both perform well.The diagnostic performance of Ni classification in NBI is better than Chen classification in WLI.

关 键 词：声带白斑 窄带成像 白光成像 诊断 

分 类 号：R76[医药卫生—耳鼻咽喉科]