BLI-ME对早期食管癌的诊断价值及B2型血管对浸润深度的判断

The diagnostic value of blue laser imaging combined with magnifying endoscopy(BLI ME)in early esophageal cancer and the judgment of the depth of invasion by type B2 blood vessels

目的:探讨蓝激光成像联合放大内镜(BLI-ME)观察下食管病变上皮内乳头状毛细血管环(IPCLs)分型对早期食管癌(EEC)的诊断价值及预估病变浸润深度的能力。方法:回顾性分析168例(174处病灶)可疑食管病变病人的临床资料,分析IPCLs对食管病变性质及浸润深度的预判作用。结果:BLI-ME诊断IPCLs A型病变中92.98%(53/57)病理诊断为食管炎,IPCLs B型病变中97.44%(114/117)病理诊断为EEC及癌前病变。BLI-ME观察下,术前活检病理与术后完整病理一致度尚可(Kappa=0.573>0.4,P<0.01);B1、B2、B3型IPCLs分型预判食管病变浸润深度的准确率分别为89.86%、61.90%、100.00%。结论:BLI-ME观察下对可疑食管病变黏膜IPCLs改变进行分型,有助于对食管黏膜性质及病变浸润深度的判断,同时在BLI-ME下靶向活检可实现对病变的精准预估,从而为治疗方案提供参考。

Objective:To explore the diagnostic value of subtyping intrapapillary capillary loops(IPCLs)in esophageal lesions using blue laser imaging combined with magnifying endoscopy(BLI-ME)and its ability to predict the depth of infiltration in early esophageal carcinoma(EEC).Methods:The clinical data of 168 patients(174 lesions)with suspicious esophageal lesions were retrospectively analyzed to study the predictive role of IPCLs in determining the nature and depth of infiltration of esophageal lesions.Results:Among the lesions with type A IPCLs,92.98%were diagnosed as esophagitis,while 97.44%of the lesions with type B IPCLs as EEC or precancerous lesions.The consistency between preoperative biopsy pathology and postoperative pathology was acceptable under BLI-ME(Kappa=0.573>0.4,P<0.01).The accuracy of predicting the depth of infiltration of esophageal lesions based on B1,B2,and B3 subtypes of IPCLs was 89.86%,61.90%,and 100.00%,respectively.Conclusions:The classification of mucosal IPCLs changes in suspected esophageal lesions under the observation of BLI-ME is helpful in determining the properties of the esophageal mucosa and the depth of lesion infiltration.Meanwhile,targeted biopsy under BLI-ME can achieve an accurate estimation of the lesions,so as to provide reference for treatment.