不同内镜技术在食管癌及癌前病变筛查中的应用价值研究
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摘要
目的:研究不同内镜技术在食管癌(EC)及癌前病变筛查中的应用价值。方法:选取行白光内镜检查后疑似食管病变的患者120例,所有患者均进行窄带成像放大内镜(NBI-ME)和超声内镜(EUS)检查。以病理学诊断结果为金标准,分析NBI-ME对早期EC及癌前病变(包括LGIN和HGIN)诊断的符合率,并对EUS的诊断符合率和浸润深度做出评价。结果:病理诊断结果显示,120例患者中, LGIN 16例, HGIN 27例,早期EC 77例。术后病理诊断为LGIN的16例患者中,NBI-ME诊断为Ⅲ型10例,Ⅳ型6例,诊断符合率为62.50%(10/16)。术后病理诊断为HGIN的27例患者中,NBI-ME诊断为Ⅳ型14例,Ⅴ_1型5例,Ⅴ_2型8例,诊断符合率为81.48%(22/27)。术后病理诊断为早期EC的77例患者中,NBI-ME诊断为Ⅴ_1型15例,Ⅴ_2型31例,Ⅴ_3型29例,Ⅴ_N型2例,诊断符合率为100%(77/77)。NBI-ME对癌前病变和早期EC的诊断符合率分别为74.42%(32/43)和100%(77/77),针对不同病变类型(LGIN、HGIN和早期EC),NBI-ME的诊断符合率差异有统计学意义(P<0.05)。与术后病理诊断相比,NBI-ME的总体诊断符合率为90.83%(109/120)。EUS诊断结果中,诊断不足8例(6.67%),诊断过度12例(10.00%),癌前病变及黏膜内癌的诊断符合率为85.71%(60/70),黏膜下癌的诊断符合率为83.33%(40/48),针对癌前病变及黏膜内癌、黏膜下癌的诊断符合率相比,差异无统计学意义(P>0.05),总体诊断符合率为83.33%(100/120)。结论:NBI-ME和EUS针对早期EC和癌前病变均有较高的诊断价值,NBI-ME能够从血管形态上反应病灶的恶性程度,EUS能够根据病灶的浸润程度对疾病进行诊断,两者联合应用可有效提高早期EC及癌前病变的诊断准确性。
Objective:To study the application value of different endoscopy techniques in the screening of esophageal cancer(EC) and precancerous lesions. Methods: 120 patients with suspected esophageal lesions after white light endoscopy were enrolled.All patients underwent narrow-band imaging magnifying endoscopy(NBI-ME) and endoscopic ultrasonography(EUS). Based on the pathological diagnosis as the gold standard, the coincidence rate of NBI-ME on the diagnosis of early EC and precancerous lesions(including LGIN and HGIN) was analyzed, and the diagnostic coincidence rate and infiltration depth of EUS were evaluated. Results: Pathological diagnosis showed that among 120 patients, 16 were LGIN, 27 were HGIN, and 77 were early EC. Among the 16 patients with pathological diagnosis of LGIN, NBI-ME was diagnosed as type III in 10 cases and type IV in 6 cases. The diagnostic coincidence rate was 62.50%(10/16). Among the 27 patients with pathological diagnosis of HGIN, NBI-ME was diagnosed as type IV in 14 cases, V_1 type in 5 cases, and V_2 type in 8 cases. The diagnostic coincidence rate was 81.48%(22/27). Among the 77 patients with pathological diagnosis of early EC, NBI-ME was diagnosed as V_1 type in 15 cases, V_2 type in 31 cases, V_3 type in 29 cases, and V_N type in 2 cases. The diagnostic coincidence rate was 100%(77/77). The diagnostic rates of NBI-ME for precancerous lesions and early EC were 74.42%(32/43) and 100%(77/77), respectively, for the diagnosis of NBI-ME for different lesion types(LGIN, HGIN, and early EC),the coincidence rate was significantly different(P<0.05).Compared with postoperative pathological diagnosis,the overall diagnostic coincidence rate of NBI-ME was 90.83%(109/120).In the EUS diagnosis,8 cases(6.67%)were not fully diagnosed,and 12 cases(10.00%)were overdiagnosed,the prevalence of precancerous lesions and intramucosal cancer was 85.71%(60/70),and the diagnostic coincidence rate of submucosal cancer was 83.33%(40/48),there was no significant difference in the diagnostic coincidence rate between precancerous lesions and intramucosal cancer and submucosal cancer(P>0.05).The overall diagnostic coincidence rate was 83.33%(100/120).Conclusion:NBI-ME and EUS have high diagnostic value for early EC and precancerous lesions.NBI-ME can reflect the malignant degree of lesions from vascular morphology,and EUS can diagnose the disease according to the degree of infiltration of the lesion.Combined application of the two can effectively improve the diagnostic accuracy of early EC and precancerous lesions.
Objective:To study the application value of different endoscopy techniques in the screening of esophageal cancer(EC) and precancerous lesions. Methods: 120 patients with suspected esophageal lesions after white light endoscopy were enrolled.All patients underwent narrow-band imaging magnifying endoscopy(NBI-ME) and endoscopic ultrasonography(EUS). Based on the pathological diagnosis as the gold standard, the coincidence rate of NBI-ME on the diagnosis of early EC and precancerous lesions(including LGIN and HGIN) was analyzed, and the diagnostic coincidence rate and infiltration depth of EUS were evaluated. Results: Pathological diagnosis showed that among 120 patients, 16 were LGIN, 27 were HGIN, and 77 were early EC. Among the 16 patients with pathological diagnosis of LGIN, NBI-ME was diagnosed as type III in 10 cases and type IV in 6 cases. The diagnostic coincidence rate was 62.50%(10/16). Among the 27 patients with pathological diagnosis of HGIN, NBI-ME was diagnosed as type IV in 14 cases, V_1 type in 5 cases, and V_2 type in 8 cases. The diagnostic coincidence rate was 81.48%(22/27). Among the 77 patients with pathological diagnosis of early EC, NBI-ME was diagnosed as V_1 type in 15 cases, V_2 type in 31 cases, V_3 type in 29 cases, and V_N type in 2 cases. The diagnostic coincidence rate was 100%(77/77). The diagnostic rates of NBI-ME for precancerous lesions and early EC were 74.42%(32/43) and 100%(77/77), respectively, for the diagnosis of NBI-ME for different lesion types(LGIN, HGIN, and early EC),the coincidence rate was significantly different(P<0.05).Compared with postoperative pathological diagnosis,the overall diagnostic coincidence rate of NBI-ME was 90.83%(109/120).In the EUS diagnosis,8 cases(6.67%)were not fully diagnosed,and 12 cases(10.00%)were overdiagnosed,the prevalence of precancerous lesions and intramucosal cancer was 85.71%(60/70),and the diagnostic coincidence rate of submucosal cancer was 83.33%(40/48),there was no significant difference in the diagnostic coincidence rate between precancerous lesions and intramucosal cancer and submucosal cancer(P>0.05).The overall diagnostic coincidence rate was 83.33%(100/120).Conclusion:NBI-ME and EUS have high diagnostic value for early EC and precancerous lesions.NBI-ME can reflect the malignant degree of lesions from vascular morphology,and EUS can diagnose the disease according to the degree of infiltration of the lesion.Combined application of the two can effectively improve the diagnostic accuracy of early EC and precancerous lesions.
引文
[1] 马海龙,张勇,邱春丽,等.中国西北地区食管癌患者照顾者生存质量及影响因素分析[J].陕西医学杂志,2016,45(2):245-247.
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[6] 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.
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[8] 胡冬梅,汤琪云,薛成俊,等.不同内镜检查方式对早期食管癌浸润深度的评估价值[J].贵州医科大学学报,2018,43(1):110-113.
[9] 赵娜,田书信,尚国臣,等.窄带成像技术、染色法及超声内镜联合使用对早期食管癌的诊断价值[J].山东医药,2014,54(28):59-61.
[10] 滕晓琨,王国品.内镜窄带成像技术在食管癌前病变诊断中的应用价值[J].中国临床研究,2016,29(11):1493-1494.
[11] 杨小乔,张刚庆,梁彪,等.内镜窄带成像技术结合染色内镜在早期食管癌诊断中的临床应用[J].内科急危重症杂志,2015,21(1):27-28,55.
[12] 丁炎波,陈炳芳,王莉,等.三种方法预测食管早癌及高级别上皮内瘤变浸润深度的对比观察[J].中华消化内镜杂志,2014,31(11):665-667.
[13] 孙文静,孙文静,刘海燕,等.NBI放大内镜联合超声内镜诊断早期食管癌23例分析[J].胃肠病学和肝病学杂志,2015,24(3):338-340.
[14] 吴琦玮,沈榕,张莉.超声微探头辅助内镜对食管癌早期筛查及癌前病变诊断价值分析[J].陕西医学杂志,2018,47(7):886-888.
[2] 何波,张立玮.早期胃食管癌内镜诊治现状与进展[J].中华临床医师杂志:电子版,2015,9(2):286-290.
[3] 尹成龙,徐芳媛,袁志萍,等.三种模式内镜检查诊断早期食管癌及癌前病变的对比研究[J].中华消化病与影像杂志:电子版,2013,3(4):8-12.
[4] 马丹,杨帆,廖专,等.中国早期食管癌筛查及内镜诊治专家共识意见(2014年,北京)[J].中国实用内科杂志,2015,35(4):320-337.
[5] 刘晓,王贵齐.早期食管癌及癌前病变内镜下治疗进展[J].中国实用内科杂志,2015,35(3):196-198.
[6] 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.
[7] 王蕾,李鹏.早期食管癌的内镜诊断进展[J].中华临床医师杂志:电子版,2014,8(22):4079-4081.
[8] 胡冬梅,汤琪云,薛成俊,等.不同内镜检查方式对早期食管癌浸润深度的评估价值[J].贵州医科大学学报,2018,43(1):110-113.
[9] 赵娜,田书信,尚国臣,等.窄带成像技术、染色法及超声内镜联合使用对早期食管癌的诊断价值[J].山东医药,2014,54(28):59-61.
[10] 滕晓琨,王国品.内镜窄带成像技术在食管癌前病变诊断中的应用价值[J].中国临床研究,2016,29(11):1493-1494.
[11] 杨小乔,张刚庆,梁彪,等.内镜窄带成像技术结合染色内镜在早期食管癌诊断中的临床应用[J].内科急危重症杂志,2015,21(1):27-28,55.
[12] 丁炎波,陈炳芳,王莉,等.三种方法预测食管早癌及高级别上皮内瘤变浸润深度的对比观察[J].中华消化内镜杂志,2014,31(11):665-667.
[13] 孙文静,孙文静,刘海燕,等.NBI放大内镜联合超声内镜诊断早期食管癌23例分析[J].胃肠病学和肝病学杂志,2015,24(3):338-340.
[14] 吴琦玮,沈榕,张莉.超声微探头辅助内镜对食管癌早期筛查及癌前病变诊断价值分析[J].陕西医学杂志,2018,47(7):886-888.