不同观察方法在预测声带白斑病理性质中的应用

Application of different observation methods in predicting the pathological properties of vocal cord leukoplakia

目的通过观察与比较窄带成像(NBI)内镜下声带白斑形态及其周围黏膜表面微血管(NI分型)特点,提出两者结合的观察方式在声带白斑诊治策略中的应用。方法回顾分析术前行NBI内镜检查的156例(男性152例、女性4例)声带白斑患者的临床资料。依次采用声带白斑形态、微血管以及两者结合的方式来预测其术后病理性质,预测结果分为高级别和低级别,以病理结果为金标准进行统计学分析。结果声带白斑周围黏膜表面上皮内乳头样毛细血管襻(IPCLs)扩张成稀疏、细小斑点状纳入低级别组的准确率要低于纳入高级别组(72.3%vs 77.7%)。基于NI分型的NBI内镜声带白斑周围黏膜表面微血管形态的预测价值均高于形态学(准确率68.1%)。而NBI内镜下微血管分型结合声带白斑形态学具有最高的准确率,达84.0%,敏感度和特异度分别为75.6%和89.5%,Kappa值为0.65。结论NI分型在预测声带白斑术后病理性质的准确性要高于形态学。形态学与微血管相结合的方式可以更好地预测声带白斑术后病理。声带白斑形态学与微血管相结合的NBI内镜检查方法值得推广。

Objective To observe and compare the morphology of vocal cord leukoplakia(VCL)and microvessels change(NI classification)under narrow band imaging(NBI),and to propose the application of a combined observation method in diagnosis and treatment of VCL.Methods The clinical data of 156 patients with VCL(152 males and 4 females)who had undergone NBI endoscopy before operation were analyzed retrospectively.The morphology of VCL,microvessels change and a combination of the two methods were used to predict postoperative pathological properties.The prediction results were divided into high-level and lowlevel,with the pathological results serving as the gold standard for statistical analysis.Results Intraepithelial papillary capillary loops(IPCLs)could expand into sparse and small spots,and inclusion accuracy in the lowlevel group was lower than that in the high-level group(72.3%vs 77.7%).The predictive value of the change in microvessels based on NI classification was higher than that of morphology(accuracy rate 68.1%).The accuracy of microvascular change combined with morphology was the highest,reaching 84.0%,with a sensitivity of 75.6%and specificity 89.5%,and the Kappa value was 0.66.Conclusions NI classification could predict the pathological properties of VCL more accurately than morphology.The combination of VCL morphology and microvessels change could better predict postoperative pathology,which deserves to be promoted.