3种不同内窥镜联合诊断对提高早期食管癌诊断率的应用价值评估

Assessment of the application value of the combined diagnosis of three kinds of endoscopies in improving the diagnostic rate of early esophageal cancer

目的:探究与分析3种不同内窥镜联合诊断在提高早期食管癌诊断率中的应用价值。方法:回顾性分析2020年3月至2022年2月新疆医科大学第一附属医院收治的110例早期食管癌和(或)癌前病变患者的临床资料,按照病理学诊断结果将其分为食管癌组(65例)和炎症组(45例),两组患者均采用超声胃镜、碘染色内窥镜以及放大电子染色内窥镜(ME-NBI)3中不同内窥镜进行早期诊断及检查。采用单因素分析探讨影响早期食管癌诊断价值的高危因素;采用logistic多因素回归分析探讨早期食管癌的诊断价值;对比不同内窥镜诊断方法对早期食管癌的诊断效能,比较染色体第一、二、三、四阶段的受试者工作特征(ROC)曲线下面积(AUC)。结果:炎症组与食管癌组的患者年龄、中位年龄、病变位置及环周面积,以及超声内窥镜下病变情况比较,差异无统计学意义(P>0.05)。炎症组与食管癌组患者的碘染色内窥镜下表现、ME-NBI上皮内乳头状毛细血管袢(IPCL)分型和草席征比较,差异有统计学意义(χ^(2)=5.995、20.168、5.960,P<0.05)。将超声胃镜、碘染色内窥镜以及ME-NBI的病灶浸润深度、碘染色改变情况以及草席征纳入logistic回归分析方程中,第四阶段的AUC明显高于第一、二及三阶段,第三阶段的AUC要明显高于第一、二阶段,第二阶段的ACU要明显高于第一阶段,ACU为9.663(95%CI:0.935~9.551)。联合内窥镜诊断早期食管癌的灵敏度、特异度均明显高于超声内窥镜、碘染色内窥镜以及ME-NBI的单独诊断结果,差异有统计学意义(χ^(2)=5.409、27.948、12.819、19.786、9.148、15.294,P<0.05)。结论:不同类型内窥镜联合诊断早期食管癌明显优于单一内窥镜检查方法,联合诊断早期食管癌具有较高的诊断准确率。

Objective:To explore and analyze the application value of the combined diagnosis of three kinds of different endoscopies in improving the diagnosis rate of early esophageal cancer.Methods:The clinical data of 110 patients with early esophageal cancer and(or)precancerous lesions,who admitted to the First Affiliated Hospital of Xinjiang Medical University from March 2020 to February 2022,were retrospectively analyzed.According to the diagnostic results of pathology,they were divided into esophageal cancer group(65 cases)and inflammation group(45 cases).Both groups of patients were diagnosed and examined by ultrasound endoscopy,iodine staining endoscopy and magnifying endoscopy with narrow band imaging(ME-NBI).Univariate analysis was used to explore the high-risk factors affecting the diagnostic value of early esophageal cancer.The logistic multivariate regression analysis was used to explore the diagnostic values of them on early esophageal cancer.The efficacies of diagnostic methods of different endoscopies for early esophageal cancer were compared.The area under curve(AUC)values of receiver operating characteristic(ROC)curves among different stages(the first,second,third and fourth stage)of chromosome were compared.Results:There were no significant differences in age,median age,lesion location,circumferential area and lesion status under ultrasound endoscope between the inflammation group and the esophageal cancer group(P>0.05).There were significant differences in the manifestations under iodine staining endoscope,ME-NBI intraepithelial papillary capillary loop(IPCL)typing and straw mat sign between the inflammation group and the esophageal cancer group(χ^(2)=5.995,20.168,5.960,P<0.05),respectively.The depth of lesion infiltration,the changes of iodine staining and straw mat sign of ultrasound gastroscopy,iodine staining endoscopy and ME-NBI were included in the logistic regression analysis equation.The results showed that the AUC value of the fourth stage was significantly higher than that of the first,second and third stages,and the AUC value of the third stage was significantly higher than that of the first and second stages,and the ACU value of the second stage was significantly higher than that of the first stage,respectively,and the AUC was 9.663(95%CI:0.935-9.551,P<0.05).In diagnosing early esophageal cancer,the sensitivity and specificity of the combined endoscopy were significantly higher than those of ultrasound endoscopy,iodine staining endoscopy and ME-NBI alone,and the differences were statistically significant(χ^(2)=5.409,27.948,χ^(2)=12.819,19.786,χ^(2)=9.148,15.294,P<0.05).Conclusion:The combined diagnosis of different types of endoscopes for early esophageal cancer is significantly better than that of a single endoscopy method,and the combined diagnosis has higher diagnostic accuracy for early esophageal cancer.