内镜窄带成像技术对早期食管癌及癌前病变的诊断价值

Narrow-band imaging in the diagnosis of early esophageal cancer and precancerous lesion

目的探讨内镜窄带成像技术(NBI)诊断早期食管癌及癌前病变的价值。方法90例经内镜检查病理诊断的早期食管癌及癌前病变患者,共138个病变,分别在普通模式和NBI模式下观察食管黏膜,用普通放大及NBI放大观察病变的腺管开口形态及毛细血管结构形态,然后应用1.2%碘液行全食管染色,对所有NBI阳性及碘染色阳性部位均取活检,所有病变均以病理结果作为诊断标准,再将病变NBI分级、碘染色分级分别与病理诊断结果对比。结果普通模式下发现病变104个(75.4%),NBI模式下发现病变120个(87.0%),碘染色发现病变138个(100.0%)。NBI模式对病变的检出率高于普通模式(P<0.05),而低于碘染色(P<0.01),但NBI模式对高级别黏膜内瘤变的检出率与碘染色无明显差别(P>0.05),主要差别在于NBI模式对低级别黏膜内瘤变的检出率低于碘染色(P<0.01)。结论NBI可清晰显示早期食管癌、癌前病变的腺管开口及毛细血管结构形态,明显优于普通内镜,NBI技术与碘染色技术的有机结合可在更大程度上提高早期食管癌、癌前病变的诊断率。

Objective To evaluate the value of narrow-band imaging （NBI） in the diagnosis of early esophageal cancer and precancerous lesion. Methods Ninety patients were diagnosed as early esophageal cancer or precancerous lesions （138 lesions）. The esophagus was examined with ordinary endoscopy and NBI endoscopy respectively, pit pattern and blood capillary form were examined with routine magnifying endoscopy and NBI endoscopy. Finally, 1.2% Lugoul＇s iodine solution was used to stain the esophageal mucosal surface, biopsy was taken at the sites which NBI or iodine staining positive, all lesions were confirmed by pathologic diagnosis as the gold standard, NBI and iodine staining scale was compared with pathologic diagnosis. Results One hundred and four （75.4%） lesions were detected with ordinary endoscopy, 120 （87.0%） lesions were detected with NBI endoscopy, 138 （100.0%） lesions were detected with iodine staining. The lesion detecting rate of NBI was lower than that of iodine staining （P 〈 0.01）, however, there was no significant difference between NBI and iodine staining for the diagnosis of high grade intraepithelial neoplasia（P 〉 0.05）, the main difference was that the detecting rate of NBI was lower than that of iodine staining for the diagnosis of low grade intraepithelial neoplasia （P 〈 0.01）. Conclusions Pit pattern and blood capillary form of early esophageal cancer and precancerous lesion could be clearly demonstrated with NBI than with ordinary endoscopy. The combination of NBI and iodine staining could raise the diagnostic rate of early esophageal cancer and precancerous lesion.