窄带成像技术结合放大内镜观察食管病变后食管上皮乳头内毛细血管袢改变的价值

Value of Narrowband Imaging Combined with Magnifying Endoscopy in Observing the Changes of Intraepapillary Papillary Capillary Loop after Esophageal Lesions

目的:探讨窄带成像技术结合放大内镜(narrowband imaging combined with magnifying endoscopy,NBI-ME)观察食管病变后食管上皮乳头内毛细血管袢(intraepapillary papillary capillary loop,IPCL)改变的价值.方法:选取2018年5月-2019年6月本院收治的食管病变患者64例,所有患者进行NBI-ME及普通白光内镜检查,观察IPCL的形态,并对病变区行病理活检.比较NBI-ME及普通白光内镜的图像清晰度评分,分析NBI分级及NBI检测的IPCL分型与病理诊断结果的关系,以病理诊断为金标准分析NBI-ME癌前病变及早期食管癌的诊断效能.结果:64例食管病变患者中,早期食管癌18例(28.13%),高级别瘤变5例(7.81%),低级别瘤变16例(25.00%),食管炎25例(39.06%).NBI-ME的图像清晰度评分明显高于普通白光内镜(P<0.05).食管炎NBI分级以Ⅲ级和阴性为主;低级别瘤变NBI分级以Ⅱ级和Ⅲ级为主;高级别瘤变和早期食管癌NBI分级均以Ⅰ级和Ⅱ级为主.食管炎IPCL分型主要呈Ⅱ型(84.00%);低级别瘤变IPCL分型呈Ⅱ、Ⅲ型,其中Ⅲ型占68.75%;高级别瘤变的IPCL主要呈Ⅲ型,占80.00%;早期食管癌IPCL分型主要呈Ⅳ型,占83.33%.NBI-ME诊断癌前病变与早期食管癌的灵敏度为87.18%,特异度为100%,漏诊率为12.82%.结论:NBI-ME能够细致观察食管病变患者的IPCL,其对癌前病变及早期食管癌的诊断效能较高.

Objective:To investigate the value of narrowband imaging combined with magnifying endoscopy(NBI-ME)in observing the changes of intraepapillary papillary capillary loop(IPCL)after esophageal lesions.Method:A total of 64 patients with esophageal lesions admitted to our hospital from May 2018 to June 2019 were selected.All patients underwent NBI-ME and ordinary white light endoscopy to observe the morphology of IPCL and conduct pathological biopsy on the lesion area.The image clarity scores of NBI-ME and common white light endoscopy were compared,and the relationship between NBI classification and IPCL typing detected by NBI and pathological diagnosis results was analyzed.The diagnostic efficacy of NBI-ME in precancerous lesions and early esophageal cancer was analyzed based on the gold standard of pathological diagnosis.Result:Among 64 patients with esophageal lesions,18 cases(28.13%)had early esophageal cancer,5 cases(7.81%)had high-grade neoplasia,16 cases(25.00%)had low-grade neoplasia,and 25 cases(39.06%)had esophagitis.The image clarity score of NBI-ME was significantly higher than that of ordinary white light endoscopy(P<0.05).The NBI grade of esophagitis was mainly gradeⅢand negative.The NBI grade of low-grade neoplasia was mainly gradeⅡandⅢ.The NBI grade of high-grade neoplasia and early esophageal cancer were mainly gradeⅠandⅡ.The IPCL of esophagitis was mainly classified as typeⅡ(84.00%).The IPCL of low-grade neoplasia was classified as typeⅡand typeⅢ(68.75%).The IPCL of high-grade neoplasia was mainly classified as typeⅢ(80.00%).The IPCL of early esophageal cancer was mainly classified as typeⅣ(83.33%).The sensitivity of NBI-ME in the diagnosis of precancerous lesions and early esophageal cancer was 87.18%,the specificity was 100%,and the rate of missed diagnosis was 12.82%.Conclusion:NBI-ME can carefully observe the IPCL of patients with esophageal lesions,and it is highly effective in the diagnosis of precancerous lesions and early esophageal cancer.