高分辨率显微内镜对胃黏膜肠上皮化生的诊断价值

Value of high-resolution microendoscopy in diagnosis of intestinal metaplasia in gastric mucosa

目的探究高分辨率显微内镜(high resolution microendoscopy,HRME)对胃黏膜肠上皮化生(gastric intestinal metaplasia,GIM)的诊断价值。方法回顾性分析20例GIM活检标本及10例正常十二指肠黏膜活检标本的HRME图片,总结图片特点,提出GIM组织的HRME诊断标准。在此基础上,对49例患者的91处可疑胃黏膜病变先进行白光内镜诊断,靶向活检后再对标本进行HRME下的成像和预诊断。将白光内镜、HRME诊断结果与病理结果比较,评估HRME对GIM的诊断价值。结果 GIM组织的HREM图像特点:小凹周围细胞排列规则,腺体呈绒毛状或宽大杵指状的基础上可见发亮的腺体边缘,绒毛结构呈周围一圈高亮、中间区域稍暗的明暗交界特征。49例患者的91处胃黏膜活检标本经病理学确诊为GIM的有57处,其中白光内镜诊断25处,HRME诊断52处,HRME对GIM的诊断明显优于白光内镜,其敏感性、特异性分别为91.23%、88.24%,与病理诊断的一致性Kappa值为0.79。结论高分辨率显微内镜对诊断GIM具有明显的敏感性、特异性以及与病理诊断的一致性,有助于GIM的早期诊断和胃癌的早期治疗。

Objective The investigate the clinical value of high-resolution microendoseopy （HRME） in the diagnosis of gastric intestinal metaplasia （GIM）. Methods＇ HRME images of 20 biopsy specimens of GIM and 10 normal duodenal mucosal biopsy specimens were analyzed to establish the diagnostic criteria for GIM. A total of 91 suspected gastric mueosal lesions in 49 patients were examined with white-light endoscopy followed by HRME examination after targeted biopsy using the established diagnostic criteria. The diagnostic value of HRME for G1M was assessed by comparing the diagnostic results of white-light endoscopy, pathological examination and HRME examination. Results The diagnostic criteria for GIM using HRIVIE were as follows： regular alignment of the cells around the villi; presence of villiform glands, which might be broadened with bright edges; a bright-dark interface in the villous structure （bright in the peripheral and slightly dark in the middle）. Of the 91 suspected lesions, 57 were pathologically identified as GIM; HRME identified 52 lesions as GIM as compared with only 25 GIM lesions identified by white-light endoscopy. The sensitivity, specificity and consistent Kappa values of HRME for GIM diagnosis was 91.23% , 88.24% and 0.79, respectively, showing a much better diagnostic performance of HRME than white-light endoscopy.Conclusion As a new imaging modality capable of real-time imaging of tissue pathology, HRME offers a valuable means for efficient and accurate identification of GIM to improve the diagnostic accuracy of GIM under gastroscopy.