NBI内镜对声带白斑病变性质的评估价值

Diagnosis Value of Narrow Band Imaging Endoscopy in Evaluating the Degenerative Properties of Vocal Cord Leukoplakia

目的探讨窄带成像(narrow band imaging,NBI)内镜对声带白斑病变性质的评估价值。方法回顾性分析95例(153侧)声带白斑患者(58例双侧,37例单侧)的临床资料,所有患者在显微喉镜手术前均进行电子喉镜检查,先用普通白光检查声带病变,再用NBI模式检查。根据NBI内镜下白斑及上皮内乳头样毛细血管袢(intraepithelial papillary capillary loop,IPCL)的形态特征,分为低危组(I型、II型、III型白斑)和高危组(IV型、V型、VI型白斑)。然后所有患者均于全麻支撑喉镜下行喉显微手术,术后切除的病变组织送病理检查,将NBI内镜评估结果与病理结果进行比较,计算NBI内镜评估病变性质的敏感性、特异性、准确性及Kappa-Cohen指数。结果153侧病变中,根据NBI内镜,123侧病灶(80.4%)评估为低危组(I型18侧,II型41侧,III型64侧),可能为良性病变,30侧病灶(19.6%)评估为高危组(IV型2侧,V型25侧,VI型3侧),可能为恶性;病理结果示121侧(79.1%)为低危组(角化过度20侧,轻度不典型增生39侧,中度不典型增生62侧),32侧(20.9%)为高危组(重度不典型增生5侧,原位癌22侧,浸润癌5侧)。NBI内镜评估除低危组中有2侧III型病变病理检查为重度不典型增生外,其余均与病理结果相符合。NBI内镜预测白斑恶性程度的敏感性为100%,特异性为97.6%,阳性预测值为90%,阴性预测值为100%,准确性为98%,Kappa-Cohen指数为90%(95%置信区间82.3%~100%)(P<0.05)。结论根据NBI内镜可较准确评估声带白斑的病变性质。

Objective To investigate the diagnosis value of narrow band imaging(NBI)endoscopy in evaluating the degenerative properties of vocal cord leukoplakia.Methods A retrospective analysis of clinical data from 95 cases(153 sides)of vocal cord leukoplakia patients was conducted.All patients underwent electronic laryngoscopy before microlaryngoscopy.The lesions of vocal cords were examined with white light and then with NBI mode.The superficial IPCL patterns were classified into six types(types I-VI).Under the NBI endoscope,the vocal cord leukoplakia was classified as 1)Group A:types I,II,and III.The pathological results were regarded as the gold standard for definitive diagnosis of vocal cord leukoplakia.and 2)Group B:types IV,V,and VI.All patients underwent laryngeal microsurgery under general anesthesia,and lesions were sent for pathological examination.The results of NBI assessment were compared with those of pathology.The sensitivity,specificity,accuracy and Kappa-Cohen index of NBI in assessing the nature of lesions were calculated.Results According to NBI endoscopy,123 lesions(80.4%)were classified as low-risk group(type I:18,type II:41,type III:64)and possibly benign lesions,while 30 lesions(19.6%)were classified as high-risk group(type IV:2,type V:25,type VI:3)and possibly malignant lesions.The pathological results showed that the 121 lesions(79.1%)were hyperkeratosis(20 lesions),mild(39 lesions),moderate atypical hyperplasia(62 lesions),and the 32 lesions(20.9%)were severe atypical hyperplasia(5 lesions),carcinoma in situ(22 lesions),and invasive carcinoma(5 lesions).In the low-risk group,2 lateral lesions were pathologically severe atypical hyperplasia.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of NBI in predicting the malignancy of leukoplacia were 100%,97.6%,90%,100%,and 98%,respectively.Kappa-Cohen index was 0.90(95%confidence interval 82.3%to 100%).Conclusion NBI endoscopy can accurately evaluate the pathological properties of vocal cord leukoplakia.