探头式激光共聚焦显微内镜在胃癌及癌前病变临床诊断中的作用

Application of probe-based confocal laser endomicroscopy in diagnosis of gastric carcinoma and precancerous lesions

目的:探讨探头式共聚焦激光显微内镜(pCLE)在胃癌及其癌前病变临床诊断中的作用。方法:选取2013年12月至2014年11月于浙江大学医学院附属第一医院及2014年1月至2017年12月于浙江中医药大学附属第一医院行pCLE上消化道检查患者的资料,根据已知胃黏膜病变的pCLE诊断标准,以病理诊断作为金标准,统计分析pCLE诊断萎缩性胃炎(AG)、胃黏膜肠上皮化生(GIM)、低级别上皮内瘤变(LGIN)、高级别上皮内瘤变(HGIN,包含胃癌)的诊断效能。结果:共纳入119例患者,共计154个胃黏膜病变。pCLE诊断AG的敏感度、特异度分别为94.34%、91.09%,符合率为92.21%,κ值为0.83。pCLE诊断GIM的敏感度、特异度分别为84.47%、92.16%,符合率为87.01%,κ值为0.72。pCLE与病理诊断完全型GIM的符合率为0.75,κ值为0.49;诊断不完全型GIM的符合率为0.79,κ值为0.48。pCLE诊断LGIN的敏感度、特异度分别为85.29%、87.50%,符合率为87.01%,κ值为0.66;pCLE诊断HGIN的敏感度、特异度分别为95.83%、97.17%,符合率为96.75%,κ值为0.92。结论:pCLE可用于诊断胃癌及癌前病变且诊断效能高,并可对GIM进行初步分型诊断。

Objective: To assess the application of probe-based confocal laser endomicroscopy(pCLE) in diagnosis of gastric carcinoma and precancerous lesions. Methods: Patients underwent pCLE in the First Affiliated Hospital of Zhejiang University School of Medicine during December 2013 and November 2014 and in the First Affiliated Hospital of Zhejiang Chinese Medical University during January 2014 and December 2017 were enrolled. The consistency between pCLE diagnosis and pathological diagnosis of gastric lesions, including atrophic gastritis, gastric intestinal metaplasia, low-grade intraepithelial neoplasia and high-grade intraepithelial neoplasia(including gastric carcinoma) was analyzed. Results: Totally 154 gastric lesions from 119 patients were detected by pCLE. Using pathological diagnosis as gold standard, the sensitivity, specificity, coincidence rate and κ value of pCLE diagnosis for atrophic gastritis were 94.34%, 91.09%, 92.21%and 0.83;those indicators for gastric intestinal metaplasia were 84.47%, 92.16%, 87.01%and 0.72. The coincidence rate and κ value of pCLE diagnosis of complete gastric intestinal metaplasia were 0.75 and 0.49;for incomplete gastric intestinal metaplasia were 0.79 and 0.48, respectively. The sensitivity, specificity, coincidence rate and κ value of pCLE diagnosis for low-grade intraepithelial neoplasia were 85.29%, 87.50%, 87.01%and 0.66;those for high-grade intraepithelial neoplasia(including gastric carcinoma) were 95.83%, 97.17%, 96.75%and 0.92. Conclusion: pCLE can be used for diagnosis of gastric carcinoma and pericancerous lesions and also for typing of gastric intestinal metaplasia.