窄带成像技术与碘染色在早期食管癌及其癌前病变诊断中的应用
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摘要
目的探讨窄带成像技术(NBI)与碘染色对早期食管癌及癌前病变的诊断价值,并评估窄带成像放大内镜(ME-NBI)预测高级别上皮内瘤变和早期食管癌浸润深度准确性。方法选择2016年1月-2018年6月在宁夏医科大学总医院内镜中心经内镜活检病理诊断为早期食管癌及癌前病变的105例(117处)病变患者,对比分析普通内镜、NBI及碘染色内镜的检出情况;高级别上皮内瘤变和早期食管癌进行ME-NBI检查,预测浸润深度,与术后病理对比判断ME-NBI预测早期食管癌浸润深度的准确率。结果早期食管癌检出率NBI为95.2%,碘染色为100.0%,两者差异无统计学意义(P>0.05);高级别上皮内瘤变NBI及碘染色的检出率分别为93.3%和100.0%,两者间差异无统计学意义(P>0.05);低级别上皮内瘤变NBI检出率(82.7%)低于碘染色的检出率(100.0%)(P<0.01);ME-NBI对高级别上皮内瘤变和早期食管癌深度判断的敏感度为60.0%、特异度96.2%、阳性预测值85.7%、阴性预测值86.2%、准确率86.1%。结论 NBI及碘染色对早期食管癌及高级别上皮内瘤变均有较好的诊断价值,对低级别上皮内瘤变NBI诊断价值不及碘染色;ME-NBI对早期食管癌及其浸润深度判断具有一定的价值,可做为临床诊断早期食管癌的有效方法。
Objective To evaluate the diagnostic value of narrowband imaging(NBI) and iodine staining in early esophageal cancer and precancerous lesions,and to evaluate the accuracy of narrowband imaging magnifying endoscopy(ME-NBI)in predicting high-grade intraepithelial neoplasia and invasion depth of early esophageal cancer. Methods From January 2016 to June 2018,105 patients(117 cases)with early esophageal cancer or precancerous lesions were diagnosed by endoscopic biopsy pathology at the endoscopic center of the General Hospital of Ningxia Medical University. The findings of ME-NBI and biopsy pathology of conventional white light endoscopy were comparatively analyzed. The accuracy of ME-NBI in diagnosis of invasive depth of early esophageal cancer was evaluated. Results The detection rates of NBI and iodine staining for early esophageal cancer were 95.2% and 100.0%,respectively,with no significant difference(P>0.05);the detection rates of NBI and iodine staining for high-grade intraepithelial neoplasia were 93.3% and 100.0%,respectively,with no significant difference between the two(P>0.05);the detection rates of NBI for low-grade intraepithelial neoplasia(82.7%)were lower than those for iodine staining(100.0%)(P<0.01);The sensitivity,specificity,positive predictive value,negative predictive value and accuracy rate were 60.0%,96.2%,85.7%,86.2% and86.1% respectively. Conclusion NBI and iodine staining have better diagnostic value for early esophageal cancer and high-grade intraepithelial neoplasia,but they are less valuable for low-grade intraepithelial neoplasia than iodine staining;ME-NBI has certain value for early esophageal cancer and its invasion depth,and can be used as an effective means for clinical diagnosis of early esophageal cancer.
Objective To evaluate the diagnostic value of narrowband imaging(NBI) and iodine staining in early esophageal cancer and precancerous lesions,and to evaluate the accuracy of narrowband imaging magnifying endoscopy(ME-NBI)in predicting high-grade intraepithelial neoplasia and invasion depth of early esophageal cancer. Methods From January 2016 to June 2018,105 patients(117 cases)with early esophageal cancer or precancerous lesions were diagnosed by endoscopic biopsy pathology at the endoscopic center of the General Hospital of Ningxia Medical University. The findings of ME-NBI and biopsy pathology of conventional white light endoscopy were comparatively analyzed. The accuracy of ME-NBI in diagnosis of invasive depth of early esophageal cancer was evaluated. Results The detection rates of NBI and iodine staining for early esophageal cancer were 95.2% and 100.0%,respectively,with no significant difference(P>0.05);the detection rates of NBI and iodine staining for high-grade intraepithelial neoplasia were 93.3% and 100.0%,respectively,with no significant difference between the two(P>0.05);the detection rates of NBI for low-grade intraepithelial neoplasia(82.7%)were lower than those for iodine staining(100.0%)(P<0.01);The sensitivity,specificity,positive predictive value,negative predictive value and accuracy rate were 60.0%,96.2%,85.7%,86.2% and86.1% respectively. Conclusion NBI and iodine staining have better diagnostic value for early esophageal cancer and high-grade intraepithelial neoplasia,but they are less valuable for low-grade intraepithelial neoplasia than iodine staining;ME-NBI has certain value for early esophageal cancer and its invasion depth,and can be used as an effective means for clinical diagnosis of early esophageal cancer.
引文
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[6]王烜,张澍田.窄带成像技术与碘染色诊断早期食管癌及癌前病变的对比研究[J].中国实用内科杂志,2009,29(8):723-725.
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[9]苏峰,朱美玲,张瑞,等.窄带成像技术与碘染色对早期食管癌及癌前病变的诊断价值和对比分析[J].医学综述,2012,18(11):1763-1765.
[10]Takahashi M,Shimizu Y,Ono M,et al.Endoscopic diagnosis of early neoplasia of the esophagus with narrow band imaging:correlations among background coloration and iodine staining findings[J].J Gastroenterol Hepatol,2014,29(4):762-768.
[11]Muto M.Endoscopic diagnostic strategy of supemcial esophageal squamous cell carcinoma[J].Dig Endosc,2013,25(1):1-6.
[12]Larghi A,Lightdale CJ,Memeo L,et al.EUS followed by EMR for staging of high-grade dysplasia and early cancer in Barrett’s esophagus[J].Gastrointest Endosc,2005,62(1):16-23.
[13]沈小春,孙文静,杨莹莹,等.窄带成像技术与碘染色对早期食管癌及癌前病变诊断的运用[J].重庆医学,2013,42(11):1235-1236.
[14]谢霞,樊超强,于劲,等.食管早期癌及上皮内瘤变内镜分型与病理的关系[J].第三军医大学学报,2014,36(24):2496-2499.
[15]冯业,李晓波,周颖,等.放大内镜结合窄带成像技术对早期食管癌及其浸润深度的诊断价值[J].胃肠病学,2016,21(10):602-605.
[2]霍亚兰.食管癌微卫星不稳定的研究进展[J].实用癌症杂志,2011,26(4):434-436.
[3]Ormeci N,Savas B,Coban S,et al.The usefulness of chromoendoscopy with methylene blue in Barrett's metaplasia and early esophageal carcinoma[J].Surg Endosc,2008,22(3):693-700.
[4]Inoue H,Kaga M,Sato Y,et al.Magnifying endoscopic diagnosis of tissue atypia and cancer invasion depth in the area of pharyngo-esophageal squamous epithelium by NBI enhanced magnification image:IPCL pattern classification[M].Oxford,UK:Blackwell Publishing Ltd,2008:49-66.
[5]Wang LD,Zhou Q,Gou RY,et al.Reproducibility of an esophageal biopsy sampling procedure in a highincidence area for esophageal cancer in northern China[J].Cancer Epidemiol Biomarkers Prev,1996,5(5):405-406.
[6]王烜,张澍田.窄带成像技术与碘染色诊断早期食管癌及癌前病变的对比研究[J].中国实用内科杂志,2009,29(8):723-725.
[7]Tanabe S,Koizumi W,Mitomi H,et al.Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer[J].Gastrointest Endosc,2002,56(5):708-713.
[8]Kuznetsov K,Lambert R,Rey JF.Narrow-band imaging:potential and limitations[J].Endoscopy,2006,38(1):76-81.
[9]苏峰,朱美玲,张瑞,等.窄带成像技术与碘染色对早期食管癌及癌前病变的诊断价值和对比分析[J].医学综述,2012,18(11):1763-1765.
[10]Takahashi M,Shimizu Y,Ono M,et al.Endoscopic diagnosis of early neoplasia of the esophagus with narrow band imaging:correlations among background coloration and iodine staining findings[J].J Gastroenterol Hepatol,2014,29(4):762-768.
[11]Muto M.Endoscopic diagnostic strategy of supemcial esophageal squamous cell carcinoma[J].Dig Endosc,2013,25(1):1-6.
[12]Larghi A,Lightdale CJ,Memeo L,et al.EUS followed by EMR for staging of high-grade dysplasia and early cancer in Barrett’s esophagus[J].Gastrointest Endosc,2005,62(1):16-23.
[13]沈小春,孙文静,杨莹莹,等.窄带成像技术与碘染色对早期食管癌及癌前病变诊断的运用[J].重庆医学,2013,42(11):1235-1236.
[14]谢霞,樊超强,于劲,等.食管早期癌及上皮内瘤变内镜分型与病理的关系[J].第三军医大学学报,2014,36(24):2496-2499.
[15]冯业,李晓波,周颖,等.放大内镜结合窄带成像技术对早期食管癌及其浸润深度的诊断价值[J].胃肠病学,2016,21(10):602-605.