摘要
目的研究共聚焦激光显微内镜(CLE)识别早期胃癌(EGC)并对其进行分类的可行性。方法选取完成CLE检查的182例患者的CLE图像,其中EGC42例,高级别上皮内瘤变9例,低级别上皮内瘤变30例,胃炎52例,肠上皮化生49例。3名熟练掌握CLE诊断技术的内镜医师,根据已制定的胃黏膜病变的CLE诊断标准,以盲法对每例患者做出CLE诊断及分类,结果与组织学诊断比较。结果CLE诊断胃癌的敏感性和特异性分别为88.1%和98.6%;如果把高级别上皮内瘤变归为癌性病变,敏感性和特异性则为90.2%和98.5%。而且,单纯依赖CLE图像区分EGC分化型和未分化型的准确性为84.9%;如果结合CLE和普通白光内镜图像,则准确性为94.4%。结论 CLE可以较准确地在体识别EGC并对其进行初步分类;CLE在EGC的诊断中具有很大价值。
Objective To evaluate the feasibility of confocal laser endomicroscopy （CLE）in the in vivo identification and stratification for early gastric cancer （EGC）. Methods A total of 182 patients （42 patients with EGC,9 patients with high grade intraepithelial neoplasia,30 patients with low grade intraepithelial neoplasia,and 52 patients with gastritis ,49 patients with intestinal metaplasia）were eligible for analysis. The CLE images obtained from all the patients were blindly evaluated by three endoscopists familiar with CLE technology according to the created CLE imaging criteria which were developed to grade gastric superficial lesions. The validity and reliability of the CLE diagnosis was accessed as compared with the tissue pathology. Results Gastric cancers could be predicted by CLE with a high sensitivity of 88. 1% and specificity of 98. 6%, and gastric＂cancerous＂ lesions（ EGC and high grade intraepithelial neoplasia）could be more easily identified by CLE （the sensitivity of 90. 2% and specificity of 98.5% ）. Moreover, EGC could be further divided into differentiated and undifferentiated carcinoma with a high accuracy（84. 9% ）by using CLE images alone, and with a higher accuracy（94. 4% ）by using both endoscopic and confocal images. Both intra-observer and inter-observer agreements were nice. Conclusions EGC could be determined and stratified with a high validity and reliability by using CLE. And so, CLE will be of great value in the diagnosis of EGC.
出处
《中华临床医师杂志（电子版）》
CAS
2012年第12期39-43,共5页
Chinese Journal of Clinicians(Electronic Edition)
关键词
胃肿瘤
显微镜检查
共焦
癌
原位
Stomach neoplasms
Microscopy, confocal
Carcinoma in situ
