窄带成像技术与碘染色诊断早期食管癌及癌前病变的对比研究

A comparative study of narrow band imaging and Lugoul's iodine staining in the diagnosis of early squamous esophageal cancer and precancerous lesions.

目的探讨窄带成像技术(NBI)对食管癌及癌前病变的诊断价值。方法对2008年5月至11月北京友谊医院4056例患者进行常规内镜、NBI、碘染色检查食管,筛查到82例114处病变,对这些病变行NBI结合放大内镜检查并靶向取活检。比较3种检查方法对病灶的诊断价值,并比较IPCL分型与病理的一致性。结果与NBI和碘染色相比,常规内镜对早期食管癌及癌前病变较易漏诊,尤其是平坦型病变。NBI和碘染色对病灶的检出率均较高(78.0%和79.8%),高级别黏膜内瘤变均主要表现为NBIⅠ级(80.4%)和碘染色Ⅰ级(85.7%),低级别黏膜内瘤变主要表现为碘染色Ⅱ/Ⅲ级(66.0%),但NBI对其不具有特异性。高级别黏膜内瘤变以IPCL形态Ⅳ、Ⅴ型表现为主(92.9%),低级别黏膜内瘤变以IPCLⅡ、Ⅲ型表现为主(89.4%),IPCL形态分型与病理诊断之间具有较好的一致性。结论碘染色及NBI对早期食管癌及癌前病变均有较高的检出率;NBI结合放大内镜观察IPCL形态,可能成为早期食管癌内镜下治疗及术后是否复发的重要依据。

Objective To evaluate the value of narrow band imaging（NBI） in the diagnosis of early squamous esophageal cancer and precancerous lesions. Methods Four thousand and fifty-six patients were examined by routine endoscopy, NBI and iodine chromoscopy,orle hundred and fourteen lesions in 82 patients were screened. Of all lesions were detected by NBI with magnification and targeted biopsy. The differences among routine endoscopy, NBI and iodine chromoscopy, and the consistency between IPCL and histological findings were assessed. Results Compared to NBI and iodine chro- moscopy,especially flat lesions, there was a high missed diagnosis rate in diagnosis of early squamous esophageal cancer and precancerous lesions by routine endoscopy. With NBI and iodine chromoscopy, the incidence rate of lesions was 78.0% and 79. 8% ,respectively. For iodine staining,85.7% Grade Ⅰ was high grade intraepithelial neoplasia（ HGIN）, and 66. 0% Grade Ⅱ/Ⅲ was low grade intraepithelial neoplasia （LGIN）. For NBI,80. 4% Grade Ⅰ was HGIN, but there was no specificity in diagnosis LGIN. In appearance of IPCL,92. 9% Type Ⅳ/Ⅴ was HGIN,89.4% Type Ⅱ/Ⅲ was LGIN, and it has a relatively better consistency in IPCL with histological findings. Conclusion There is a high detection rate in diagnosis of early squamous esophageal cancer and precancerous lesions by Lugours iodine staining and NBI endoscopy. It＇s probably that IPCL patterns by NBI with magnification can provide scientific basis for both the endoscopic theraphy of early esophageal cancer and the omen of postoperative recurrence.