窄带成像结合放大内镜技术观察胃表面微血管在早期胃癌诊断中的价值

Value of magnifying endoscopy with narrow band imaging to observe microvascular architecture for diagnosis of early gastric cancer

目的探讨窄带成像结合放大内镜技术(magnifying endoscopy with narrow band imaging,ME-NBI)观察胃病变表面微血管形态分型对判断早期胃癌分化程度的临床价值。方法采用ME-NBI技术观察200例具有可疑病灶患者的病变表面微血管形态,参照Nakayoshi分型及Yokoyama分型对其微血管形态进行判断,将其分为FNP、ILL-1、ILL-2及CSP四型,之后对病变部位活检进行病理观察,将ME-NBI观察到的微血管形态分型与病理结果进行比较。结果 200例患者中36例病理确诊为早期胃癌,32例确诊为低级别上皮内瘤变(LGIN)。分化型腺癌组中,FNP型占10%、ILL-1型占60%、ILL-2型占25%、CSP型占5%,ILL-1型的发生率显著高于ILL-2型(χ2=5.013,P<0.05);未分化型腺癌组中,ILL-2型占43.7%、CSP型占56.3%,CSP型发生率高于ILL-2型,但差异无统计学意义(χ2=0.5,P>0.05);LGIN组中,FNP型占62.5%、ILL-1型占37.5%,但差异无统计学意义(χ2=4.0,P>0.05);FNP、CSP、ILL-1、ILL-2型在不同分化程度病变中的差异有统计学意义(χ2=61.894,P<0.05)。100%的FNP型及80%的CSP型存在于凹陷型病变中;50%的ILL-1型存在于平坦及平坦隆起型病变中,50%存在于隆起型病变中;91.7%的ILL-2型存在于平坦及平坦隆起型病变中。结论应用ME-NBI观察病变表面微血管形态分型可帮助我们评估早期胃癌的分化情况。

Objective To investigate the clinical value of magnifying endoscopy with narrow band imaging（ MENBI） to observe microvascular architecture classification in the assessment of the differentiation of early gastric cancer.Methods Using ME-NBI technique to observe the microvascular architecture of the lesions which were suspected of early gastric cancer in 200 patients. According to the Nakayoshi type and Yokoyama type,narrow-band imaging magnifying images were classified into four categories based on abnormal microvascular patterns： FNP,ILL-1,ILL-2 and CSP.After then,biopsy of the lesion for histological examination was observed. The ME-NBI classification was compared with the histopathological. Results Thirty-six patients were diagnosed for early gastric cancer and 32 patients were low-grade intraepithelial neoplasia（ LGIN）. Amongst the differentiated-type adenocarcinoma lesions,FNP,ILL-1,ILL2 and CSP were observed in 10%,60%,25% and 5%,the incidence of ILL-1 was significantly higher than that of ILL-2（ χ2=5. 013,P〈0. 05）; In undifferentiated-type adenocarcinoma lesions,ILL-2 and CSP were observed in 43. 7% and56. 3%（ χ2= 0. 5,P〉0. 05）; In LGIN lesions,FNP and ILL-1 were observed in 62. 5% and 37. 5%（ χ2= 4. 0,P〉0. 05）. 100% of the FNP and 80% of the CSP type existed in the depressed lesion; 50% of the ILL-1 type existed in the flat and flat-elevated lesion,50% were in the elevated lesions; 91. 7% of the ILL-2 type existed in the flat and flatelevated lesion. Conclusion Using ME-NBI to observe the microvascular architecture classification of the lesion can help us to evaluate the differentiation of early gastric cancer.