内镜精查对胃低级别上皮内瘤变早癌筛查的价值

Endoscopic Fine Examination for Early Cancer Screening in Patients With Gastric Low-grade Intraepithelial Neoplasia

背景:普通白光内镜检查及其指导的活检存在局限性,可能造成早癌漏诊或误诊。目的:探讨内镜精查对胃低级别上皮内瘤变(LGIN)患者早癌筛查的价值。方法:选取2016年8月—2019年2月在常州市中医医院经普通内镜活检病理诊断为胃LGIN的患者50例,于3个月后进行复查,对其中30例有典型Ⅱa、Ⅱc或Ⅱa+Ⅱc形态改变者行放大内镜联合窄带成像(ME-NBI)精查和内镜黏膜下剥离术(ESD)治疗。结果:根据VS分类标准,30例行内镜精查者中15例提示早癌,15例提示非癌病变。精查活检病理提示高级别上皮内瘤变(HGIN)或胃癌10例,LGIN或慢性炎症改变20例。最终ESD病理显示14例为HGIN或胃癌,16例为LGIN或慢性炎症改变。以ESD病理结果为金标准,内镜精查诊断胃早癌的敏感性和阴性预测值均为100%,显著高于普通内镜活检病理和精查活检病理(P<0.05)。结论:对于普通内镜活检病理提示胃LGIN者,ME-NBI精查可提高早癌检出率,防止漏诊。

Background:There are limitations in diagnosis based on common white light endoscopy(C-WLE)and guided forcep biopsy,which may lead to missing or misdiagnosis of early cancer.Aims:To evaluate the value of endoscopic fine examination for early cancer screening in patients with low-grade intraepithelial neoplasia(LGIN).Methods:Fifty patients with gastric LGIN diagnosed by C-WLE-based pathology from Aug.2016 to Feb.2019 at Changzhou Hospital of Traditional Chinese Medicine were enrolled.All the patients were reexamined three months later,of them 30 patients with typical morphological changes ofⅡa,Ⅱc andⅡa+Ⅱc underwent endoscopic fine examination with magnifying endoscopy and narrow-band imaging(ME-NBI)for screening of early cancer.Endoscopic submucosal dissection(ESD)was also performed.Results:According to VS classification,15 of the 30 patients having endoscopic fine examination performed were diagnosed as early cancer and the other 15 were diagnosed as non-cancerous lesions.Pathology based on biopsy under endoscopic fine examination revealed 10 high-grade intraepithelial neoplasia(HGIN)/gastric cancer and 20 LGIN/chronic inflammation.Pathology based on ESD revealed 14 HGIN/gastric cancer and 16 LGIN/chronic inflammation.Taken ESD pathology as the gold standard,the sensitivity and negative predictive value of endoscopic fine examination for diagnosis of early gastric cancer both were 100%,significantly higher than those of C-WLE-and ME-NBI-biopsy pathology(P<0.05).Conclusions:Endoscopic fine examination with ME-NBI can improve the detection of early cancer and prevent missing diagnosis in patients with gastric LGIN indicated by C-WLE-biopsy.