ME-FICE联合超声小探头对早期胃癌及癌前病变的诊断价值研究

Application of ME-FICE combined with small ultrasound probe in the diagnosis of early gastric cancer and precancerous lesions

目的:探究放大智能电子分光染色技术(ME-FICE)联合超声小探头在早期胃癌及其癌前病变诊断中的应用价值。方法:选取2021年4月至2022年4月期间武汉市红十字会医院收治的80例疑似胃癌患者,使用ME-FICE区分阳性和(或)阴性,再使用高频超声小探头对病灶进行浸润深度探查。检查结束后在ME-FICE模式下对病灶明显处进行活检,其病检阳性者根据患者意愿对病灶行内窥镜下黏膜切除术(EMR)、内窥镜黏膜下剥离术(ESD)或外科手术切除,以术后病检结果为诊断“金标准”。采用Kappa一致性检验评价ME-FICE联合超声小探头与病检结果对良恶性诊断、内窥镜下浸润深度评估以及术后浸润深度评估的一致性。结果:ME-FICE联合超声小探头良恶性诊断的灵敏度、特异度及准确率分别为90.63%、79.17%和83.75%,均处于较高水平,Kappa值为0.887,与病例活检结果具有良好的一致性;ME-FICE联合超声小探头检查浸润程度评估的灵敏度、特异度和准确率分别为66.67%、90.00%和81.25%,灵敏度较差,其余处于较高水平,Kappa值为0.803,与术后病理结果具有良好的一致性。结论:ME-FICE联合超声小探头适用于早期胃癌及癌前病变的诊断,能够提高疾病诊断灵敏度及准确率,并能在术前进行较为准确的浸润程度评估,为后续手术选择和治疗提供指导。

Objective:To explore the application value of magnifying endoscope and flexible spectral imaging colour enhancement(ME-FICE)combined with small ultrasound probe in the diagnosis of early gastric cancer and precancerous lesions.Methods:A total of 80 patients with suspected gastric cancer who admitted to Wuhan Red Cross Hospital from April 2021 to April 2022 were selected,and the ME-FICE was used to distinguish positive and/or negative lesions,and then,small ultrasound probe with high-frequency were used to explore the depth of the infiltration of the lesions.After the examination,biopsy should be performed on the obvious position of lesion under FICE mode.The endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD)or surgical resection were performed on the lesions according to the different intentions of the positive patients.The result of postoperatively pathological examination was the"gold standard"for diagnosis.Kappa consistency test was used to evaluate the consistency of benign and malignant diagnosis,the assessment of infiltration depth under endoscope and the assessment of infiltration depth after surgery between ME-FICE combined with small ultrasound probe and pathological examination.Results:The sensitivity,specificity and accuracy of ME-FICE combined with small ultrasound probe were respectively 90.63%,79.17%and 83.75%for benign and malignant diagnosis,which were at higher levels.The Kappa value of that was 0.887,which had favorable consistency with the result of biopsy for cases.The sensitivity,specificity and accuracy of ME-FICE combined with small ultrasound probe were respectively 66.67%,90.00%and 81.25%for the assessment of infiltration degree,indicating poor sensitivity and higher level of other indicators,with a Kappa value of 0.803,which had favorable consistency with postoperatively pathological results.Conclusion:ME-FICE combined with small ultrasound probe is suitable for the diagnosis of early gastric cancer and precancerous lesions,which can improve the sensitivity and accuracy of disease diagnosis,and more accurately assess the degree of infiltration before surgery,and provide guidance for subsequently surgical selection and treatment.