普通白光联合窄带成像放大内镜对早期胃癌浸润深度的诊断价值

Diagnostic value of conventional white light endoscopy combined with magnification endoscopy with narrow-band imaging in determining the infiltration depth of early gastric cancer

目的:建立普通白光内镜(conventional white light endoscopy,C-WLE)联合窄带成像放大内镜(magnifying endoscopy with narrow-band imaging,ME-NBI)诊断早期胃癌(early gastric cancer,EGC)浸润深度的模型,提高EGC深度诊断的准确性。方法:回顾性分析2018年1月至2020年10月河北医科大学第四医院行黏膜下剥离术(endoscopic submucosal dissection,ESD)或手术治疗的241例EGC患者,用χ^(2)检验分析EGC黏膜下深层浸润的危险因素,应用Logistic回归模型分析EGC黏膜下深层浸润内镜下表现的独立危险因素,构建预测EGC浸润深度模型。结果:χ2检验结果表明黏膜皱襞变化、易出血、溃疡、边缘隆起、无血管区、扩张血管、微血管结构缺失、表面结构缺失是EGC黏膜下深层浸润的危险因素。Logistic多因素回归分析表明溃疡(OR=5.696,95%CI:1.656~19.590;P=0.006),边缘隆起(OR=5.363,95%CI:1.469~19.573;P=0.011),无血管区(OR=8.990,95%CI:2.522~32.042;P=0.001),扩张血管(OR=8.435,95%CI:3.323~21.408;P<0.001)为EGC黏膜下深层浸润的独立危险因素。将上述独立危险因素分别赋分为4分、4分、5分、5分,构建预测浸润深度的模型,AUC为0.802,最佳临界点为8分,诊断敏感度为71.4%,特异度为85.6%,准确率为82.5%。结论:依据C-WLE联合ME-NBI诊断EGC黏膜下深层浸润的独立危险因素构建的诊断模型有助于术前准确诊断EGC的浸润深度。

Objective:To establish a model of conventional white light endoscopy(C-WLE)combined with magnifying endoscopy with narrow-band imaging(ME-NBI)for accurately determining the infiltration depth of early gastric cancer(EGC).Methods:The data of 241 patients with EGC,who underwent endoscopic submucosal dissection(ESD)or surgery in The Fourth Hospital of Hebei Medical University between January 2018 and October 2020,were retrospectively analyzed.The risk factors of deep submucosal infiltration of EGC were analyzed by chi-square test.A Logistic regression model was used to analyze the independent risk factors of endoscopic manifestations of EGC submucosal deep invasion,and to construct a model for predicting the EGC invasion depth.Results:Mucosal fold change,bleeding,ulceration,marginal elevation,non-vascular regions,dilated blood vessels,and absence of microvascular architecture and surface structure were risk factors for EGC submucosal deep infiltration.Ulceration(odds ratio[OR]=5.696,95%confidence interval[CI]:1.656–19.590,P=0.006),marginal elevation(OR=5.363,95%CI:1.469–19.57,P=0.011),non-vascular regions(OR=8.990,95%CI:2.522–32.042,P=0.001),and dilated blood vessels(OR=8.435,95%CI:3.323–21.408,P<0.001)were independent risk factors for EGC submucosal deep infiltration,and these were assigned 4,4,5,and 5 points,respectively.Using this data,a prediction model of EGC infiltration depth was constructed,with an area under the curve(AUC)of 0.802.The model had a cut-off score of 8 points,sensitivity of 71.4%,specificity of 85.6%,and diagnostic accuracy of 82.5%.Conclusions:This noveldiagnostic model constructed based on the independent risk factors of C-WLE combined with ME-NBI helps in diagnosing EGC submucosal deep infiltration and aids in accurately determining the depth of EGC infiltration preoperatively.