窄带成像技术结合放大内镜在早期胃癌诊断中的价值研究

Combination of magnifying endoscopy and narrow band imaging in diagnosis of early gastric cancer

目的评价窄带成像技术（NBI）结合放大内镜在早期胃癌诊断中的应用价值。方法2008年3月至2008年12月经普通内镜发现存在胃黏膜可疑病灶且符合研究要求的患者共56例，行NBI结合放大内镜及靛胭脂染色检查，对NBI、靛胭脂染色诊断的胃黏膜腺管及微血管形态的清晰程度评分进行比较。内镜检查之后对所检查部位进行靶向活检，将NBI结合放大内镜及靛胭脂染色检查结果及病理检查结果进行比较。结果56例中有16例经病理诊断为早期胃癌。将NBI结合放大内镜及靛胭脂染色检查结果及病理检查结果进行统计得出：NBI结合放大内镜诊断早期胃癌的诊断符合率、敏感性、特异性、假阳性率、假阴性率分别为94．6％（53／56）、93．8％（15／16）、95．0％（38／40）、5．0％（2／40）、6．3％（1／16）；靛胭脂染色诊断早期胃癌的诊断符合率、敏感性、特异性分别为91．1％（51／56）、87．5％（14／16）、92．5％（37／40），假阳性率、假阴性率分别为7．5％（3／40）、12．5％（2／16）；二者比较差异均无统计学意义（P均〉0．05）。NBI、靛胭脂染色诊断的胃黏膜腺管及微血管形态的清晰程度评分结果对比显示：NBI与靛胭脂染色在腺管结构显示方面无明显差别，但NBI显示微血管形态明显优于靛胭脂染色。结论NBI结合放大内镜可以提供清晰的胃黏膜血管图像，有助于早期胃癌的诊断，可提高活检检查的准确性，与靛胭脂染色联用可提高早期胃癌的诊断率。

Objective To evaluate the use of magnifying endoscopy combined with narrow band imaging （NBI） system in diagnosis of early gastric cancer. Methods From March 2008 to December in 2008, a total of 56 patients with suspected gastric mucosal lesions were enrolled in the study. The lesions were observed with magnifying endoscopy combined with NBI and indigo-earmine-chromoendoscopy, and the results were compared with pathologic diagnosis from targeted biopsies. Results Out of 56 patients, 16 were diagnosed as early gastric cancer pathologically. The accordance rate with the pathological diagnosis, sensibility, specificity, false positive rate and false negative rate of the magnifying endoscopy combined with NBI system were 94. 6% （53/56）, 93.8% （ 15/16）, 95.0% （38/40）, 5.0% （2/40） and 6. 3% （ 1/16）, respectively; while those of chromoendoscopy were 91.1% （51/56） , 87. 5% （14/16）, 92. 5% （37/40） , 7.5% （3/40） and 12. 5% （2/16）, respectively （P 〉 0. 05）. There was no difference between NBI and chromoendoscopy in regarding of observing pit pattern, however, NBI was superior in displaying intrapapillary capillary loop. Conclusion Combination of magnifying endoscopy and NBI provides clear images of gastric mucosa and intrapapillary capillary, which is useful in diagnosis of early gastric cancer and can improve accuracy of biopsy. When combined with chromoendoscopy, it can further improve the yield of diagnosis.