放大内镜结合窄带成像技术在老年胃癌早期及癌前病变中的诊断价值

Diagnostic value of magnifying endoscopy combined with narrow-band imaging in early-stage and precancerous lesions of gastric cancer in the elderly

目的观察放大内镜结合窄带成像技术(ME-NBI)在老年胃癌早期及癌前病变中的诊断价值。方法回顾性分析福建医科大学教学医院福建省老年医院2019年1月至2021年12月收治入院时疑似老年胃癌早期及癌前病变患者58例,并接受常规内镜检查与ME-NBI检查,并经内镜下病理检查为金标准确诊的患者。根据病理金标准,分析常规内镜检查与ME-NBI检查的诊断敏感度与特异度,明确诊断价值。结果病理检查结果:7例良性病变,23例癌前病变,19例胃癌早期,9例进展期癌。而在其他两种检查结果分析,ME-NBI检查结果为5例良性病变,23例癌前病变,21例胃癌早期,9例进展期癌。在常规检查检查结果为8例良性病变,19例癌前病变,20例胃癌早期,11例进展期癌。在胃癌早期的诊断价值比较中,白光内镜和ME-NBI两种检查在敏感度比较中,差异无统计学意义(P>0.05)。而在癌前病变的敏感度与特异度、胃癌早期特异度的比较中,ME-NBI检查高于常规检查,差异有统计学意义(P<0.05)。结论在疑似老年胃癌早期及癌前病变的患者检查中,由于老年胃退化机制的影响下,采取放大内镜结合窄带成像技术实施检查,较常规内镜检查,能获得更高的诊断敏感度与特异度,以为临床实施早期治疗,提供参考依据。

Objective To explore the diagnostic value of magnifying endoscopy combined with narrow-band imaging(ME-NBI)in early-stage and precancerous lesions of gastric cancer in the elderly.Methods A total of 58 elderly patients with suspected early-stage and precancerous lesions of gastric cancer who were admitted to the Teaching Hospital of Fujian Medical University,underwent conventional endoscopy with ME-NBI and were diagnosed by endoscopic pathological examination(gold standard)from January 2019 to December 2021 were retrospectively analyzed.Using the pathological gold standard as a benchmark,the diagnostic sensitivity and specificity of conventional endoscopy and ME-NBI examination were analyzed comparatively to clarify the diagnostic value.Results Pathological examination revealed benign lesions in 7 patients,precancerous lesions in 23 patients,early-stage gastric cancer in 19 patients,and progressive gastric cancer in 9 patients.While in the analysis of the other 2 examination results,ME-NBI examination revealed benign lesions in 5 patients,precancerous lesions in 23 patients,early-stage gastric cancer in 21 patients,and progressive gastric cancer in 9 patients.Conventional endoscopy examination revealed benign lesions in 8 patients,precancerous lesions in 19 patients,early-stage gastric cancer in 20 patients,and progressive gastric cancer in 11 patients.There was no statistically significant difference between conventional endoscopy examination and ME-NBI examination in the sensitivity for the diagnosis of early-stage gastric cancer(P>0.05).In contrast,the sensitivity and specificity for the diagnosis of precancerous lesions and the specificity for the diagnosis of early-stage gastric cancer by ME-NBI examination were higher than those by conventional endoscopy examination,with statistically significant differences(P<0.05).Conclusion In the examination of elderly patients with suspected early-stage and precancerous lesions of gastric cancer,ME-NBI can achieve higher diagnostic sensitivity and specificity than conventional endoscopy due to the degenerative mechanism of the stomach of the elderly,which can provide a reference basis for early clinical treatment.