内镜下卢戈液染色与卢戈液-亚甲蓝双重染色诊断食管浅表性病变对比研究

Comparative study of double staining with Lugol ’ s solution and methylene blue and single-staining with Lugol ’ s solution in the diagnosis of esophageal superficial lesions

目的:比较卢戈液染色与卢戈液-亚甲蓝双重染色诊断食管浅表性病变的价值。方法:对298例食管浅表性病变先后用3%卢戈液和0.5%亚甲蓝染色,观察病变染色程度及范围,行活组织病理学检查,将染色结果与病理诊断进行比较。结果:早期癌101例,高级别上皮内瘤变23例,低级别上皮内瘤变81例,非上皮内瘤变93例。卢戈液染色,早期癌和高级别上皮内瘤变多呈不染色,其特异性和敏感性分别为96.0%(167/174)、89.5%(111/124);低级别上皮内瘤变和非上皮内瘤变多呈淡染色,其特异性和敏感性分别为61.8%(134/217)、91.4%(74/81)和57.6%(118/205)、75.3%(70/93)。卢戈液-亚甲蓝双重染色,早期癌和高级别上皮内瘤变多呈卢戈液不染色-亚甲蓝深染色,其特异性和敏感性是99.4%(173/174)、86.3%(107/124);低级别上皮内瘤变多呈卢戈液淡染色-亚甲蓝淡染色,其特异性和敏感性分别为96.8%(210/217)、81.5%(66/81);非上皮内瘤变多呈卢戈液淡染色-亚甲蓝不染色,其特异性和敏感性分别为100.0%(205/205)、69.9%(65/93)。卢戈液-亚甲蓝双重染色诊断早期癌和高级别上皮内瘤变与卢戈液染色相似,z=0.076,P=0.939 1;但诊断低级别上皮内瘤变和非上皮内瘤变,双重染色的特异性明显高于卢戈液染色,z=3.155,P=0.001 6和z=4.148,P<0.000 1。结论:卢戈液-亚甲蓝双重染色能准确判断食管浅表性病变性质,且鉴别低级别上皮内瘤变和非上皮内瘤变明显优于卢戈液染色。

OBJECTIVE：To compare the diagnostic accuracy of double staining with LugoL ’ s solution and methylene blue and single-staining with LugoL ’ s solution in diagnosing esophageal superficial lesions.METHODS：Esophageal superficial lesions（298patients） were sprayed with 3% LugoL ’ s solution firstly,and then 0.5% methylene blue.Depending on the mucosal staining,biopsies specimen was obtained,the result of staining and pathology was contrasted.RESULTS：The patients included 101early esophageal cancer（EEC） and 23high-grade intraepithelial neoplasias（HGEN） and 81low-grade intraepithelial neoplasias（LGEN） and 93non-intraepithelial neoplasias（NEN）.After staining with LugoL ’ s solution,EEC and HGEN were mostly non-stained,the specificity and sensitivity were 96.0%（167 / 174） and 89.5%（111 / 124）;LGEN and NEN were mostly weakly stained,the specificity and sensitivity for LGEN and NEN were 61.8%（134 / 217）,91.4%（74 / 81） and 57.6%（118 / 205）,75.3%（70 / 93）.After double staining with LugoL ’ s solution and methylene blue,EEC and HGEN were mostly deeply stained by methylene blue but non-stained by LugoL ’ s solution,the specificity and sensitivity were 99.4%（173 / 174） and 86.3%（107 / 124）;LGEN was mostly weakly stained by methylene blue and LugoL ’ s solution,the specificity and sensitivity were 96.8%（210 / 217） and 81.5%（66 / 81）,NEN was mostly nonstained by methylene blue but weakly stained by LugoL ’ s solution,the specificity and sensitivity was 100.0%（205 / 205） and 69.9%（65 / 93）.The specificity for EEC and HGEN with LugoL ’ s solution staining or double staining was similar（z=0.076,P = 0.939 1）,but the specificity for LGEN and NEN with double staining was higher than that with LugoL ’ s solution staining（z= 3.155,P=0.001 6;z=4.148,P〈0.000 1）.CONCLUSION：The double staining with LugoL ’ s solution and methylene blue can exactly diagnose and identify esophageal superficial lesions,and it is better than LugoL ’ s solution staining in distinguishing LGEN from NEN.