共聚焦激光显微内镜对大肠管状腺癌的诊断价值

Diagnostic value of confocal laser endomicroscopy for colorectal tubular adenocarcinoma

目的 通过共聚焦激光显微内镜（CLE）观察大肠管状腺癌的镜下组织学特点,制定高、中、低分化腺癌的诊断依据,评价CLE诊断大肠管状腺癌的价值.方法 首先对12个经病理证实为大肠管状腺癌的病变（高分化腺癌4个,中分化腺癌4个、低分化腺癌4个）进行CLE图像分析,制定CLE诊断管状腺癌的依据.然后应用该依据对49个大肠肿物进行前瞻性CLE诊断,最终将CLE诊断结果与病理诊断结果作比较,评价CLE的诊断效率.结果 CLE诊断管状腺癌的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为94.7%、90.9%、93.9%、100.0%和76.9%;CLE诊断高分化腺癌的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为100%、83.3%、8 8.9%、85.7%和87.0%;CLE诊断中分化腺癌的敏感度、特异度、准确率阳性预测值和阴性预测值分别为86.7%、90.5%、86.1%、86.7%和90.5%;CLE诊断低分化腺癌的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为77.8%、92.6%、88.9%、100.0%和86.2%.结论 共聚焦激光显微内镜可以诊断大肠管状腺癌,并能够对大肠管状腺癌进行分级诊断.CLE可以成为一种诊断大肠管状腺癌的新工具.

Objective To establish diagnostic standards of colorectal tubular adenocarcinoma with confocal laser endomicroscopy（CLE）, and to evaluate its diagnostic value in vivo.Methods The confocal images of 12 cases, which were pathologically confirmed colorectal tubular adenocarcinoma（4 well differentiated, 4 moderately differentiated and 4 poorly differentiated）, were collected and analyzed to establish diagnostic standards of the disease with CLE.Then 49 lesions were prospectively evaluated based on CLE standards,which were compared to histopathology results.Results The sensitivity, specificity, accuracy, positive predictive value（PV ＋）and negative predictive value（PV -）of CLE in diagnosing tubular adenocarcinoma were 94.7%, 90.9%, 93.9%, 100% and 76.9%, respectively.The corresponding data of well differentiated adenocarcinoma were 100%, 83.3%, 88.9%, 85.7% and 87.0%, those of moderately differentiated adenocarcinoma were 86.7%, 90.5%, 86.1%, 86.7% and 90.5%, and those of poorly differentiated adenocarcinoma were 77.8%, 92.6%, 88.9%, 100% and 86.2%.Conclusion CLE is able to diagnose and grade colorectal tubular adenocarcinoma.