放大胃镜联合窄带成像技术诊断早期胃癌的应用价值

The Value of Narrow-band Imaging Combined with Magnifying Endoscopyand Ordinary White Light Endoscopy in the Diagnosis of Early Gastric Cancer

目的:研究放大胃镜联合窄带成像技术(magnifying endoscopy-narrow-band imaging,ME-NBI)在早期胃癌(early gastric cancer,EGC)诊断准确性的应用价值。方法:回顾性分析笔者所在医院消化内科2015年6月1日-2017年5月31日行普通白光胃镜(white light gastroscopy,WLE)检查发现黏膜异常病变的42例患者,检出疑似早期胃癌病变(如粘膜色泽异常或形态异常)48处,所有纳入研究患者均再次行放大胃镜联合NBI检查,上述疑似早癌病变均行黏膜组织活检并完善病理学检查,以病理学诊断结果为金标准,从而将研究结果进行对比分析。结果:在上述48处病灶中,病理学诊断6处为癌变,分别统计两组检查方法在诊断早期胃癌的符合率,WLE组为56.25%(27/48),ME-NBI组为93.75%(45/48)。ME-NBI组明显高于WLE组,差异有统计学意义(P<0.05)。结论:普通白光胃镜目前仍然是临床工作中筛查早期胃癌的首选手段,但发现疑似早癌病变后需进一步行ME-NBI观察,以便提高胃癌的早期诊断。

Objective：To compare the accuracy of magnifying gastroscopy with narrow-band imaging （ME-NBI） and white light endoscopy （WLE） in the diagnosis of early gastric cancer, and to discuss the diagnostic value of ME-NBI for early gastric cancer.Method：A retrospective analysis of 42 patients with abnormal mucosal lesions by （white light gastroscopy,WLE） from June 1,2015 to May 31,2017 in the Department of Gastroenterology was conducted.Totally 48 suspected early gastric cancer lesions （such as abnormal mucosal morphology or color） were identified.All included patients underwent re-examination with ME-NBI.The suspected lesions underwent tissue biopsy and were sent for pathological examination.The pathological diagnosis results were regarded as the gold standard.Concordance,sensitivity,specificity,false positive rate and false negative rate of ME-NBI and WLE were compared.Result： Of the 48 lesions mentioned above, 6 were diagnosed as cancerous by pathology.The coincidence rate of the two methods in the diagnosis of early gastric cancer was 56.25% （27/48） in WLE group and 93.75% （45/48） in ME-NBI group.The difference between ME-NBI group and WLE group was statistically significant （P〈0.05）.Conclusion： WLE is still the first choice for clinical screening for early gastric cancer.Concordance of ME-NBI for early diagnosis of gastric cancer is significantly higher than that of WLE,therefore,it is necessary to further observe with ME-NBI after identifying suspected early cancer lesions in order to improve early diagnosis of gastric cancer.