蓝激光成像结合放大内镜对早期食管癌的诊断价值

Diagnostic value of magnifying endoscopy with blue laser imaging for early esophageal cancers

目的评价蓝激光成像（BLI）结合放大内镜对早期食管癌的诊断价值。方法2015年4月至2016年12月对普通内镜依据黏膜形态或色泽发生异常改变筛查出的153处局灶性病变分别行白光单独放大、BLI结合放大内镜（M-BLI）、复方碘溶液染色检查，以活检组织的病理诊断为金标准，评价M—BLI、复方碘溶液染色内镜下诊断与病理诊断的一致性。结果病理诊断结果中，在153例病灶中，食管炎或黏膜组织慢性炎19例，低级别上皮内瘤变92例，高级别上皮内瘤变或者早癌42例。对于早期食管癌的筛查，白光内镜单独放大、M—BLI、复方碘溶液染色内镜诊断的敏感度分别66．7％（28／42）、95．2％（40／42）、95．2％（40／42），特异度分别为57．7％（64／111）、91．9％（102／111）、92．8％（103／111），与病理诊断的总体符合率分别为60．1％（92／153）、92．8％（142／153）、93．5％（143／153），Kappa值分别为0．565、0．891、0，906。M-BLI下对早癌的检出情况较白光内镜高（z。=9．166，P=0．002）。结论M-BLI对早期食管癌诊断的检出情况与复方碘溶液染色内镜相似，BLI操作方便，且可避免碘染所致的碘过敏者、碘染色的操作时间长、患者不容易耐受等缺点。

Objective To evaluate the magnifying endoscopy with blue laser imaging（M-BLI） for early esophageal cancers. Methods A total of 153 focal esophageal lesions detected with conventional white light endoscopy （WLE） based on changes of mucosal shape and color were enrolled in this study. Patients were examined with WLE, M-BLI, and 1.25% Lugol＇s iodine chromoendoscopy between April 2015 and December 2016. Diagnostic consistency of M-BLI and Lugol＇s iodine chromoendoscopy were evaluated with pathology as a golden standard. Results Pathological diagnosis showed there were 19 lesions of esophagitis or chronic mucosal inflammation, 92 of low grade intraepithelial neoplasia, and 42 high grade intraepithelial neoplasia or early cancer. Diagnostic sensitivities of WLE, M-BLI and Lugol＇s iodine chromoendoscopy of screening early cancer were 66. 7% （ 28/42 ）, 95. 2% （ 40/42 ）, and 95. 2% （ 40/42 ） respectively, the speeificities were 57. 7% （ 64/111 ）, 91.9% （ 102/111 ）, and 92. 8% （ 103/111 ） respectively. The consistency rate between endoscopy and pathological examination were 60. 1% （92/153）, 92. 8% （ 142/153）, and 93.5% （143/153） respectively, and the Kappa values were O. 565, O. 891, and O. 906 respectively. The detection rate of M-BLI was higher than that of WLE alone （X2 = 9. 166, P = 0. 002 ）. Conclusion The diagnostic value of M-BLI for early esophageal cancer is similar to that of Lugol＇s iodine chromoendoscopy. However, M-BLI is easier to operate, and superior to Lugol＇s iodine staining endoscopy in the absence of iodine allergy, long operating time and patients＇ intolerance.