NBI联合放大内镜诊断胃癌的临床价值分析

Clinical value analysis of NBI combined magnifying endoscopy in diagnosis of gastric cancer

目的探讨窄带成像技术(NBI)联合放大内镜诊断胃癌的临床价值。方法选取经普通内镜初步诊断的150例胃癌可疑患者的临床资料。所有患者均接受了NBI联合放大内镜检查及病理学活组织检查。比较NBI联合放大内镜检查与普通内镜检查的图像清晰度,判断不同病理类型患者的腺管开口分型;以病理检查结果为诊断金标准,计算NBI联合放大内镜诊断与普通内镜诊断的灵敏度、特异度、漏诊率、误诊率。结果 NBI联合放大内镜检查150例胃癌可疑患者的病变轮廓、黏膜腺管开口形态、浅表毛细血管结构及形态的图像清晰度评分均明显优于普通内镜,差异均有统计学意义(P﹤0.01);NBI联合放大内镜检查腺管开口分型显示,慢性浅表性胃炎患者的腺管开口分型主要为Ⅱ型,胃黏膜萎缩、肠上皮化生患者主要为Ⅲ型,轻-中度非典型增生及早期胃癌患者主要为Ⅳ型;NBI联合放大内镜诊断胃癌的灵敏度为93.75%,特异度为94.07%,漏诊率为6.25%,误诊率为5.93%;普通内镜诊断胃癌的灵敏度为65.63%,特异度为74.58%,漏诊率为34.38%,误诊率为25.42%。结论NBI联合放大内镜诊断胃癌的价值优于普通内镜。

Objective To investigate the clinical value of narrow band imaging（NBI） combined with magnifying endoscopy in diagnosis of gastric cancer. Method The clinical data of 150 patients with suspected gastric cancer diagnosed by preliminary routine endoscopy were collected. All 150 patients underwent NBI combined with magnifying endoscopy and types of adenotracheal openings in patients with different pathological types were evaluated. Taking the pathological results as the gold standard for diagnosis, sensitivities, specificities, omission diagnostic rates and misdiagnosis rates in diagnosis of gastric cancer between routine endoscopy and NBI combined with magnifying endoscopy were calculated. Re Result The image resolution scores of NBI combined with magnifying endoscopy on lesion contour, mucosal gland opening image morphology, superficial structure of capillaries were significantly better than those in routine endoscopy（P〈0.01）. On NBI combined with magnifying endoscopy showed type Ⅱ mucosal gland opening in patients with chronic superficial gastritis, type Ⅲ of mucosal gland opening in patients with mucosal atrophy and intestinal metaplasia, type Ⅳ of mucosal gland opening in patients with mild to moderate atypical hyperplasia and early gastric cancer. The sensitivity,specificity, omission diagnostic rate and misdiagnosis rate of NBI combined with magnifying endoscopy in diagnosis of gastric cancer were 93.75%, 94.07%, 6.25%, and 5.93%; and the sensitivity, specificity, omission diagnostic rate and misdiagnosis rate of routine endoscopy in diagnosis of gastric cancer were 65.63%, 74.58%, 34.38%, and 25.42%, respectively. Conclusion Compared with routine endoscopy, the diagnostic value of NBI combined with magnifying endoscopy is better in diagnosis of gastric cancer.