窄带成像内镜对声带白斑诊断价值的探讨

Diagnostic value of narrow band imaging laryngoscope for vocal fold leukoplakia

目的探讨窄带成像(narrow band imaging,NBI)喉镜对声带白斑的诊断价值。方法选取门诊并住院手术的声带白斑患者62例,每例患者均用白光和NBI模式的电子喉镜进行观察,根据电子喉镜NBI模式的诊断结果,所有病变声带分为两组:第1组为单纯鳞状上皮增生,可伴有角化过度或角化不全,属于NBI分型Ⅲ型;第2组为不典型增生和原位癌,属于NBI分型Ⅳ型和Ⅴa型。以病理结果为诊断金标准,比较NBI模式电子喉镜与病理检查结果的一致性。结果 NBI内镜的诊断准确性在第1组和第2组中分别为77.78%(28/36)和89.58%(43/48),采用Kappa一致性检验法,κ=0.681,P<0.001,因此NBI内镜检查法和病理检查法的诊断结果存在一致性。进一步用非参数MannWhitneyU检验对NBI分型与临床病理分化之间的相关性进行分析,发现NBI内镜的诊断分型与病理分化程度之间存在明显相关性(P=0.001)。结论 NBI喉镜能清晰显示黏膜表层的微细结构,能很好地分辨白斑病变的不典型增生程度,为临床治疗方法的选择提供依据。

OBJECTIVE To investigate the value of narrow band imaging (NBI)electronic laryngoscopy for the diagnosis of vocal fold leukoplakia.METHODS A total of 62patients including 84lesions were enrolled in this study. All the lesions were divided into two groups according to the NBI classification.Group one:squamous hyperplasia with hyperkeratosis or parakeratosis,which belongs to NBI type Ⅲ.Group two:mild or moderate dysplasia (MD)or severe dysplasia (SD),or carcinoma in situ (CIS),which belongs to NBI type Ⅳ or type Va.RESULTS The diagnostic accuracy of NBI for Group one and Group two was 77.78%(28/36)and 89.58%(43/48),respectively,and the kappa index was 0.681 and P<0.001,which was considered statistically significant.Moreover,we found the significant correlation between NBI classification and pathologic differentiation (The correlation coefficient 0.658,P=0.001). CONCLUSION NBI can clearly show the outline of mucosa and the capillary pattern and can roughly estimate the degree of dysplasia.It provides the basis for the choice of clinical treatment methods.