内镜智能分光比色技术对早期食管癌及癌前病变的诊断价值

Flexible spectral imaging color enhancement for diagnosis of early esophageal carcinomas and pre- cancerous lesions

目的探讨内镜智能分光比色技术（FICE）对早期食管癌及癌前病变的诊断价值。方法257例食管可疑病变患者分别接受FICE染色内镜、FICE染色放大内镜、2％Lugol液染色内镜、2％Lugol液染色放大内镜检查，并将内镜检查结果与活检病理结果进行对比分析。结果FCIE染色内镜诊断早期食管癌的阳性率为92．6％（25／27），Lugol液染色内镜诊断早期食管癌的阳性率为88．9％（24／27），两者比较差异无统计学意义（P=0．642）；FICE染色放大内镜诊断早期食管癌的阳性率为96．3％（26／27），Lugol染色放大内镜诊断早期食管癌的阳性率为92．6％（25／27），两者比较差异亦无统计学意义（P=0．556）。FICE染色放大内镜可清晰观察乳头内毛细血管袢（IPCL）形态并进行分型，早期食管癌和高级别上皮内瘤变IPCL分型主要为Ⅳ和V型，低级别上皮内瘤变和食管炎主要为Ⅱ和Ⅲ型，正常食管主要为I型；而2％Lugol液染色放大内镜尚不能清晰观察IPCL分型。FICE染色内镜模式下无不良反应发生；2％Lugol液染色内镜下不良反应发生率为12．8％（33／257）。结论FICE染色放大内镜能准确判断早期食管癌病理分型，提高食管癌及癌前病变的诊断率，是Lugol液染色内镜的有效补充。

Objective To evaluate the flexible spectral imaging color enhancement （FICE） system in the diagnosis of early esophageal carcinoma and precancerous lesions. Methods A total of 257 patients with suspicious esophageal lesions were examined successively by FICE, magnifying FICE, iodine dyeing en- doscopy and magnifying iodine dyeing endoscopy. Findings were compared with the pathologic diagnosis. Re- suits The positive rates of early esophageal carcinoma by FICE （92. 6%, 25/27） and iodine dyeing endos- copy （88. 9%, 24/27） were not significantly different （P =0. 642）, nor were those of magnifying FICE （96. 3 %, 26/27 ） and magnifying iodine dyeing endoscopy （92. 6%, 25/27 ）, （ P = 0. 556）. The magnif- ying FICE could reveal the IPCL of early esophageal carcinoma clearly. Early esophageal carcinoma and ad- vanced neoplasia were mainly type Ⅳ ＋ Ⅴ, low-level neoplasia and esophagitis were type Ⅱ ＋ Ⅲ, and nor- mal esophagus was type I. However, the magnifying iodine dyeing endoscopy was not able to reveal IPCL. There was no adverse reaction in FICE, but the adverse reaction rate was 12. 8% （33/257） in iodine dyeing endoscopy. Conclusion Magnifying FICE can accurately determine the pathological types of early esopha- geal carcinoma, which is an effective complement to iodine dyeing endoscopy.