内镜联合窄带成像技术靶向活检用于早期胃癌诊断的研究

Endoscopic Combined Narrow Band Imaging Targeted Biopsy for the Diagnosis of Early Gastric Cancer

目的探讨普通胃镜与内镜联合窄带成像技术靶向活检用于早期胃癌诊断中的价值。方法选择2016年10月至2017年10月来我院行普通胃镜检查发现有可疑病变的50例患者作为观察对象,采取NBI-ME进一步观察,并于病变区取活检行常规病理检查。以病理结果作为金标准,比较NBI-ME与普通胃镜诊断早期胃癌的检出率。结果纳入病例的50例患者中,病理结果提示早期胃癌的为7例,普通胃镜及NBI-ME诊断早期胃癌例数分别为13例和9例。NBI-ME较普通胃镜诊断早期胃癌的灵敏度、特异度、误诊率、漏诊率、阳性预测值、阴性预测值、准确率分别为:57.1%、79.1%、20.9%、42.9%、30.8%、91.9%、76.0%和85.7%、93.0%、7.0%、14.3%、66.7%、97.6%、92.0%。其中NBI-ME组诊断早期胃癌灵敏度、特异度、误诊率、漏诊率、阳性预测值、准确率均高于普通胃镜组,差异有统计学意义(χ2=20.028 0、P=0.0000,χ2=8.047 8,P=0.004 6,χ2=8.047 8,P=0.004 6,χ2=20.028 0、P=0.0000,χ2=25.792 3,P=0.0000,χ2=36.945 2,P=0.0000),而在阴性预测值的比较中,两组无明显差异(χ2=3.265 7,P=0.070 7)。结论普通胃镜是用于筛查早期胃癌常用的方法,对于考虑为早期胃癌的患者,可采取内镜联合窄带成像技术靶向活检帮助诊断,NBI-ME诊断早期胃癌与病理诊断结果存在较好的一致性,有助于提高内镜下早期胃癌的检出率。

Objective To investigate the value of conventional gastroscope and endoscopic combined with narrowband imaging targeted biopsy in the diagnosis of early gastric cancer.Methods From October 2016 to October 2017,50 patients with suspicious lesions found in our hospital underwent routine gastroscopy were selected as observation subjects and further examined by NBI-ME.The patients were examined by routine biopsy in the diseased area.With pathological results as the gold standard,the detection rate of NBI-ME and conventional endoscopy in the diagnosis of early gastric cancer was compared.Results Pathological findings of 50 patients showed that early gastric cancer was 13 cases,common gastroscopy and NBI-ME diagnosis of early gastric cancer cases were 7 cases and 9 cases.The sensitivity,specificity,misdiagnosis rate,misdiagnosis rate,positive predictive value and negative predictive value were 57.1%,79.1%,20.9%,42.9%,30.8%,91.9% and 76.0% respectively,NBI-ME was 85.7%,93.0%,7.0%,14.3%,66.7%,97.6%,90.2%.The sensitivity,specificity,misdiagnosis rate,misdiagnosis rate,positive predictive value and accuracy of NBI-ME group in diagnosing early stage gastric cancer were all higher than those in common gastroscope group（χ^2= 20.028 0,P=0.0000,χ^2= 8.047 8,P=0.004 6,χ^2=8.047 8,P=0.004 6,χ^2=20.028 0,P=0.0000,χ^2=25.792 3,P=0.0000,χ^2=36.945 2,P=0.0000）and there was no significant difference between the two groups in the negative predictive value（χ^2= 3.265 7,P=0.070 7）.Conclusion Gastroscopy is a commonly used method for screening of early gastric cancer.For patients considered as early gastric cancer,endoscopy combined with narrow-band imaging can be used to target the biopsy for diagnosis.NBI-ME has a better diagnosis of early gastric cancer and pathological diagnosis Consistency,help to improve the detection rate of early gastric cancer under endoscopy.