窄带成像技术在咽喉部肿瘤早期诊断中的应用

Application of narrow band imaging in early diagnosis of pharyngolaryngeal tumors

目的：探讨窄带成像技术（NBI）在咽喉部肿瘤早期诊断中的应用价值。方法：使用NBI内镜对106例怀疑咽喉部良性或恶性病变患者进行检查,对白光和NBI内镜下发现的病变分别评估白光和NBI模式下病变表面毛细血管形态和病变边界的清晰度。然后分别对两种模式下可疑部位进行活检,标本保存在10%甲醛中送病理检查,并记录两种模式下病变的特征、部位及镜下诊断。所有患者根据活检病理组织学结果行相应的喉肿物切除术,以手术切除组织的病理组织学结果为诊断的金标准。分别计算两组恶性病变活检检出率及活检正确检出率,并进行统计学比较。结果：白光模式镜下诊断正确率75.47%,NBI模式镜下诊断正确率96.23%,两者差异有统计学意义（χ2=18.375,P〈0.01）;白光模式下活检正确检出率82.08%,NBI模式下活检正确检出率95.28%,两者差异有统计学意义（χ2=12.071,P〈0.01）;白光模式内镜下恶性肿瘤正确检出率48.15%,NBI模式内镜下恶性肿瘤正确检出率92.59%,两者差异有统计学意义（χ2=10.083,P〈0.01）。结论：NBI内镜下观察咽喉黏膜表面毛细血管的形态变化,能够提高早期咽喉癌的检出率,值得推广。

Objective：To investigate the application value of narrow band imaging （NBI） in early diagnosis of pharyngolaryngeal tumors. Method：A total of 106 patients received NBI endoscopy in the endoscopic diagnosis. Lesions found under the white-light endoscopy mode and NBI endoscopy mode were compared in the morphology of capillaries on lesion surface and the clarity of lesion rim. Biopsy was performed in suspected areas with those two endoscopies for the lesions found under white-light endoscopy and NBI endoscopy, the morphology of capillar- ies on the surface of lesion and the clarity of lesion boundary were compared between both. Biopsy was performed for suspected areas under two modes, and specimens were preserved in 10% formaldehyde for pathological exami- nation. The characteristic, position and endoscopic diagnosis under two modes were recorded. All the patients un- derwent corresponding laryngeal tumor resection according to the histopathological result of biopsy, and the his- topathological result of resected tissues was taken as the gold standard for diagnosis. The biopsy detection rate and biopsy correct detection rate of malignant lesions in two groups were calculated and statistical compared. Result： The diagnostic accuracy under white-light mode was 75.47%, while that under NBI mode was 96.23%, and the difference between them was statistically significant （ 2 = 18. 375, P〈 0.01）. The biopsy correct detection rate under white-light mode was 82.08%, while that under NBI mode was 95.28%, and the difference between them was statistically significant （X2= 12. 071, P〈0.01）. The correct detection rate of malignant tumor under white- light mode was 48.15%, while that under NBI mode was 92.59%, and the difference between them was statisti-cally significant （X2 = 10. 083, P〈0.01）. Conclusion： Using NBI endoscopy to observe the morphological changes of capillaries on the pharyngolaryneal mucosa surface can increase the detection rate of early pharyngolaryngeal tumors, so it is worth to be widely applied.