摘要
目的评价共聚焦激光显微内镜（confocal laser endomicroseopy，CLE）对胃部溃疡型病变的鉴别诊断价值。方法将CLE普通内镜模式下诊断为胃部溃疡型病变的患者纳入研究，转为CLE共聚焦内镜模式，对溃疡边缘和（或）表面黏膜进行扫查。随后对相同部位行黏膜活检，将CLE检查结果与病理组织学结果进行对比。结果共43例患者入选，扫查部位150个，获得图像12769幅。与病理组织学结果比较，CLE诊断炎性病变的敏感度为83．54％、特异度为85．92％、阳性预测值为86．84％、阴性预测值为82．43％；诊断上皮内瘤变的敏感度为53．57％、特异度为88．52％、阳性预测值为51．72％、阴性预测值为89．26％；诊断胃癌的敏感度为88．37％、特异度为93．46％、阳性预测值为84．44％、阴性预测值为95．24％。在CLE与病理诊断的一致性检验中，对于炎性病变的κ值为0．69，上皮内瘤变的κ值为0．42，胃癌的κ值为0．81。结论CLE对于胃部溃疡型病变的组织学类型可作出即刻诊断，其诊断的敏感度、特异度、阳性预测值、阴性预测值均较高，有利于指导靶向活检，提高癌前病变及胃癌的检出率。
Objective To estimate the value of confocal laser endomicroscopy （CLE）for differential diagnosis of gastric ulcer. Methods Patients diagnosed as gastric ulcer by conventional endoscopic mode of CLE were enrolled. The confocal endoscopic mode of CLE was used to observe the borderline and/or the surface of the ulcers. Biopsy specimen was taken for histopathological examination and the result of CLE was compared with histopatbological finding. Results A total of 12 769 CLE images were obtained from 150 sites of 43 patients. The sensitivity and specificity of CLE for phlegmonosis process were 83. 54% and 85. 92%, respectively, with positive predictive value of 86. 84% and negative predictive value of 82.43%. Whereas the sensitivity and specificity of CLE for intraepithelial neoplasia were 53. 57% and 88. 52%, respectively, with positive predictive value of 51.72% and negative predictive value of 89. 26%. As for diagnosis of gastric cancer, the sensitivity and specificity of CLE were 88. 37% and 93. 46%, respectively, with positive predictive value of 84. 44% and negative predictive value of 95. 24%. The kappa values for agreement of histopathological findings and CLE for diagnosis of phlegmonosis process, intraepithelial neoplasia and gastric cancer were 0.69,0.42 and 0.81, respectively. Conclusions CLE can provide a real-time histopathological diagnosis of the gastrointestinal tract with high sensitivity, specificity, positive and negative predictive values. Targeted biopsy can be done under CLE and the detective rates of precancerous lesions and tumors will be increased.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2010年第1期3-6,共4页
Chinese Journal of Digestion
关键词
胃溃疡
胃肿瘤
显微镜检查
共焦
诊断
Gastric ulcer
Stomach neoplasms
Microscopy, confocal
Diagnosis
