放大内镜结合窄带成像下微腺管密度对124例胃早期肿瘤性病变的诊断价值

Value of magnifying endoscopy with narrow-band imaging in diagnosis of 124 early gastric neoplastic lesions

目的：探讨放大内镜结合窄带成像（ME-NBI）下腺管间质距离（IP）的比值对胃早期肿瘤性病变的诊断价值。方法纳入2012年9月至2015年5月，经白光内镜诊断为胃内存在疑诊为浅表型肿瘤性病变的患者124例，其中男87例，平均年龄为（63.2±7.9）岁；女37例，平均年龄为（62.6±8.2）岁。所有入组的患者均进行胃镜精查，即先在白光内镜下观察，然后行 ME-NBI 观察，记录白光内镜、ME-NBI 下血管和表面结构（VS）分型、IP 特征，并行靶向活组织检查。依据病变形态特征、内镜活组织检查病理，行内镜黏膜下层剥离术（ESD）或手术治疗。分析白光内镜、VS 分型结合 IP 比值与最终病理结果的符合程度。率的比较采用卡方检验。绘制 ROC 曲线比较白光内镜和 ME-NBI 对早期胃癌的诊断准确性。结果124例患者中有118例完成内镜精查，共观察病变162处，其中161处病变纳入统计学分析。共发现低级别上皮内瘤变（LGIN）84例，高级别上皮内瘤变（HGIN）63例，黏膜内癌7例，黏膜下癌7例。在非肿瘤性病变（即 LGIN）中，分界线[32.1%（27／84）比96.1%（74／77）]、不规则的表面腺管[45.2%（38／84）比87.0%（67／77）]、不规则的黏膜微血管[16.7%（14／84）比62.3%（48／77）]、腺管密度增加[48.8%（41／84）比85.7%（66／77）]、黏膜微血管密度增加[21.4%（18／84）比80.5%（62／77）]出现的频率均低于肿瘤性病变（包括 HGIN、黏膜内癌、黏膜下癌），差异均有统计学意义（χ2＝67.6、29.1、33.5、22.9、53.7，P 均＜0.05）。白光内镜和 ME-NBI 诊断早期胃癌的敏感度分别为89.6%和94.8%，特异度分别为61.9%和83.3%，AUC 分别为0.84和0.93，ME-NBI 诊断早期胃癌的敏感度较白光内镜高，差异有统计学意义（χ2＝49.0，P ＜0.01）。VS 分型和 VS 分型结合 IP 比值诊断早期胃癌的敏感度分别为90.9%和94.8%，特异度为81.0%和83.3%，AUC 为0.89和0.93，VS 分型结合 IP 比值诊断早期胃癌的敏感度高于单纯 VS 分型，差异有统计学意义（χ2＝41.0，P ＜0.01）。结论与白光内镜相比，ME-NBI 对胃浅表型肿瘤性病变具有更高的诊断准确性，IP 比值有助于对胃浅表性肿瘤性病变的诊断。

Objective To investigate the value of intervening part （IP）ratio under magnifying endoscopy with narrow-band imaging （ME-NBI ）in the diagnosis of early gastric neoplastic lesions. Methods From September 2012 to May 2015 ,a total of 124 patients with suspected superficial gastric neoplastic lesions under white light endoscope （WLI）were enrolled,87 male with mean age of （63.2 ± 7.9）years old and 37 female with mean age of （62.6±8.2）years old.All the enrolled patients received precision endoscopy examination,which were observed under WLI at first followed by ME-NBI.Vessel, surface classification and IP features of the lesions under WLI and ME-NBI were recorded,and targeted biopsies were performed.Patients received endoscopic submucosal dissection （ESD）or surgery according to lesions features,histopathological results.Agreement rate between WLI,VS classification with IP ratio and the histopathological results were analyzed.Chi-square test was performed for rate comparision Receiver operator characteristic （ROC）curve was drawn to compare the diagnostic accuracy in early gastriccancer （EGC）between WLI and ME-NBI.Results Among the 124 patients,a total of 118 patients completed precision endoscopy examination.A total of 162 lesions were detected,and 161 of which were analyzed.A total of 84 low grade intraepithelial neoplasia （LGIN）,63 high grade intraepithelial neoplasia （HGIN）, seven mucosal cancer and seven submucosal cacinoma were detected. The incidences of demarcation line （32.1 %（27/84）vs 96.1 %（74/77））,irregular microsurface pattern （45 .2%（38/84）vs 87.0%（67/77））,irregular-microvascular pattern （16.7%（14/84）vs 62.3%（48/77 ））,increased gland tube density （48.8%（41/84）vs 85 .7%（66/77 ））and increased microvessel density （21 .4%（18/84）vs 80.5 %（62/77））of non-cacinoma lesions （LGIN）were significantly lower than those of cacinoma lesions （including HGIN, mucosa cancer and submucosa cacinoma ）, and the differences were statistically significant （χ2 =67.6,29.1 ,33.5 ,22.9,53.7,all P 〈0.05）.The sensitivities of WLI and ME-NBI in EGC diagnosis were 89.6% and 94.8%,respectively;the specificities were 61 .9% and 83.3%, respectively,area under curve （AUC）were 0.84 and 0.93,respectively.The diagnostic accuracy of ME-NBI in early gastric cancer was higher than that of WLI,and the difference was statistically significant （χ2 =49.0, P 〈0.01）.The sensitivities of vessel plus surface （VS）classification and VS classification with IP ratio were 90.9% and 94.8%,respectively;and the specificities were 81 .0% and 83.3%,respectively;AUC were 0.89 and 0.93,respectively.The diagnostic sensitivity of vessel classification with IP ratio was higher than that of simple vessel classification,and the differnce was statistically significant （χ2 =41 .0, P 〈0.01）.Conclusion Compared with WLI,the diagnostic accuracy of ME-NBI is higher in gastric superficial neoplasia lesions,and IP ratio is helpful in diagnosis of gastric superficial neoplasia lesions.