电子喉镜及窄带成像内镜下不同分型对声带白斑病理性质的预测研究

The Research of Prognosis and Evaluation of Vocal Cord Leukoplakia by Different Classifications of Narrow Band Imaging Endoscopy and White Lighting Endoscopy

目的:探讨电子喉镜及窄带成像内镜下4种分型与声带白斑病理性质之间的相关性。方法:分析行手术明确病理性质的46例声带白斑患者的临床资料。应用受试者工作特征曲线(ROC)比较4种分型方式判断声带白斑病理性质的性能,同时选择最佳截断点,并应用Kappa检验比较4种分型(最佳截断点)预测声带白斑性质与组织病理学结果的一致性。结果:白光模式NI分型预测声带白斑病理性质的准确度、灵敏度、特异度分别为72.41%、75.00%、70.59%,曲线下面积为0.728;白光模式CHEN分型分别为81.03%、87.50%、76.47%,曲线下面积为0.838;NBI模式ELS分型分别为75.86%、79.17%、73.53%,曲线下面积为0.763;NBI模式NI分型分别为89.66%、83.33%、94.12%,曲线下面积为0.933。白光模式CHEN分型的最佳截断点为3,即光滑平坦型、光滑隆起型归为良性病变,粗糙型归为恶性病变;NBI模式NI分型的最佳截断点为5,即Ⅰ~Ⅳ型为良性病变,Ⅴ、Ⅵ型为恶性病变;在最佳截断点下4种分型与组织病理学结果的一致性的Kappa值分别为0.445、0.621、0.514、0.784。结论:NBI模式NI分型(最佳截断点)预测病变的性质与组织病理学结果的一致性最高,其次为白光模式CHEN分型。

Objective:To explore the correlation between the pathological characteristics of vocal cord leukoplakia and the four classification methods,so as to select the appropriate classification and the appropriate cut-off point.Methods:The clinical data of 46 patients with vocal cord leukoplakia whose pathological characteristics were confirmed by surgery were analyzed.The receiver operator characteristic(ROC)was used to compare the performance of four classification methods to predict the pathological types of vocal cord leukoplakia,and the best cut-off point was selected at the same time.Kappa test was used to compare the consistency of the four classification methods(the best cut-off point)to predict the pathological characteristics of vocal cord leukoplakia with the histopathological results.Results:The accuracy,sensitivity and specificity of NI classification in WLI in predicting the pathological results of vocal cord leukoplakia are 72.41%,75.00%,70.59%,and area under curve is 0.728;CHEN classification in WLI are 81.03%,87.50%,76.47%,and area under curve is 0.838;ELS classification in NBI are 75.86%,79.17%,73.53%,and area under curve is 0.763;NI classification in NBI are 89.66%,83.33%,94.12%,and area under curve is 0.933.The best cut-off point of CHEN classification in white light endoscopy is 3,that is,smooth and flat type,smooth and elevated type are classified as benign lesions,while rough type is classified as malignant lesions;The best cut-off point for NI classification in NBI endoscopy is 5,that is,typeⅠ~Ⅳis benign,and typeⅤandⅥare malignant.Under the appropriate cut-off point,the kappa values of the four classifications were 0.445,0.621,0.514 and 0.784,respectively.Conclusion:At the appropriate cut-off point,the NBI NI classification was the most effective,followed by the white light CHEN classification.