普通白光内镜、超声内镜及放大内镜结合窄带显像在早期胃癌内镜治疗适应症中的临床价值

Clinical Value of White Light Image,Endoscopic Ultrasonography and Magnifying Endoscopy with Narrow Band Imaging in Evaluation of Indications for Endoscopic Treatment of Early Gastric Cancer

目的探讨普通白光内镜(white light image,WLI)、超声内镜(endoscopic ultrasonography,EUS)、放大内镜结合窄带显像(magnifying endoscopy with narrow band imaging,ME-NBI)技术在早期胃癌内镜治疗适应症中的应用价值,为临床诊疗决策提供依据。方法纳入2013年12月–2020年10月在四川大学华西医院行内镜下黏膜剥离术且术后病理证实为早期胃癌患者的临床资料,比较WLI和EUS判断早期胃癌浸润深度的准确性、敏感性、特异性、阳性预测值、阴性预测值;分析ME-NBI预测早期胃癌分化类型的作用。结果共纳入280例患者(291处病变),其中行EUS检查199例(207处病变),ME-NBI检查160例(168处病变)患者。结果显示WLI诊断早期胃癌浸润深度的准确率为87.0%,优于EUS(46.4%,P<0.001),即使两者联合诊断准确性(87.4%)相较于单独使用WLI(87.0%)也并无明显提高。ME-NBI判断早期胃癌分化程度的总体准确率为92.3%(155/168),未分化型早期胃癌ME-NBI判断准确率低于分化型早期胃癌(41.2%vs.98.0%,P<0.001)。结论在早期胃癌内镜治疗适应症的评估中,WLI可较好的预测病变浸润深度,EUS价值有限;ME-NBI能较为准确地预测绝大部分早期胃癌的分化程度,尤其是分化型早期胃癌。

Objective To explore the application value of white light image(WLI),endoscopic ultrasonography(EUS)and magnifying endoscopy with narrow band imaging(ME-NBI)in the endoscopic treatment of early gastric cancer(EGC),and to provide basis for decision-making in clinical diagnosis and treatment.Methods The clinicopathological data of EGC patients who underwent endoscopic submucosal dissection(ESD)at West China Hospital,Sichuan University between December 2013 and October 2020 were included.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of EGC invasive depth were compared between WLI and EUS.The role of ME-NBI in predicting the differentiation types of EGC was analyzed.Results A total of 280 patients(291 lesions)were enrolled in the study.Among them,199 patients(207 lesions)received EUS and 160 patients(168 lesions)received ME-NBI.The overall accuracy of WLI in diagnosing the invasive depth of EGC was 87.0%,significantly higher than that of EUS(46.4%,P<0.001).When WLI was combined with EUS,the diagnostic accuracy(87.4%)was not significantly improved.The overall accuracy of determining the differentiation degree of EGC with ME-NBI was 92.3%(155/168),and the accuracy of determining undifferentiated EGC with ME-NBI was significantly lower than that of differentiated EGC(41.2%vs.98.0%,P<0.001).Conclusion In the evaluation of indications for endoscopic treatment of EGC,WLI showed better performance in predicting the invasive depth of EGC,while EUS demonstrated limited value.ME-NBI showed better accuracy for predicting the differentiation degree of most EGC,especially for differentiated EGC.