放大内镜结合窄带成像在食管浅表性病变靶向活检中的应用价值被引量：5

Magnifying Endoscopy Combined with Narrow-band Imaging for Targeted Biopsy of Superficial Lesions in Esophagus

下载PDF

导出

摘要背景：食管癌为常见消化道恶性肿瘤,早期诊断是改善预后的关键。因此,寻求提高早期食管癌内镜检出率的方法具有重要临床意义。目的：评价放大内镜结合窄带成像（ME-NBI）指导的靶向活检对食管可疑浅表性病变的诊断准确性。方法：采用前瞻性交叉试验设计,纳入常规胃镜检查发现食管存在可疑浅表性病变的患者65例,随机进入A组或B组。A组先行白光（WLI）染色内镜（Lugol液染色）＋随机活检,4~6周后行ME-NBI＋靶向活检,B组反之。以井上上皮乳头内毛细血管襻（IPCL）分型为标准指导靶向活检。结果：58例患者完成研究,68处病变可作为研究对象。WLI染色内镜平均活检数量多于ME-NBI（3.7对2.2,P〈0.05）。IPCL分型与最终病理结果的总体符合率为89.7%。ME-NBI靶向活检与WLI染色内镜随机活检结果总体符合率为85.3%,两者诊断肿瘤性病变的特异性和阳性预测值均为100%,敏感性ME-NBI优于WLI染色内镜（90.0%对70.0%,P〈0.05）,与最终病理结果的符合率亦略高于WLI染色内镜（89.7%对86.8%,P〉0.05）。结论：对于食管浅表肿瘤性病变,ME-NBI指导的靶向活检较WLI染色内镜随机活检具有更高的敏感性,且可减少活检数量,有利于后续内镜治疗。 Background： Esophageal cancer is a commonly seen gastrointestinal malignancy. Early detection of superficial neoplastic lesions is critical for improving the prognosis. Therefore,it is of great importance to explore new endoscopic techniques for increasing the detection rate of early esophageal cancer. Aims： To assess the diagnostic accuracy of targeted biopsy guided by magnifying endoscopy combined with narrow-band imaging（ ME-NBI） for suspected superficial lesions in esophagus. Methods： In a prospective cross-over designed trial,65 patients with suspected superficial lesions in esophagus detected by conventional gastroscopy were randomly assigned to group A and group B. Patients in group A received primary white light imaging（ WLI） with Lugol＇s staining followed by ME-NBI 4-6 weeks later,and patients in group B received primary ME-NBI followed by WLI with Lugol＇s staining 4-6 weeks later. Random biopsy was performed in WLI with Lugol＇s staining,while targeted biopsy was performed in ME-NBI based on Inoue＇s intraepithelial papillary capillary loop（ IPCL） classification. Results： A total of 58 patients completed the study and 68 lesions were eligible for statistical analysis. More biopsies were taken in WLI with Lugol＇s staining than in ME-NBI（ 3. 7 vs. 2. 2 per lesion,p〈0. 05）.The overall agreement of IPCL classification with definite pathological diagnosis was 89. 7%. The overall agreement of targeted biopsy by ME-NBI and random biopsy by WLI with Lugol＇s staining was 85. 3%; the specificity and positive predictive value of both ME-NBI and WLI with Lugol＇s staining for neoplastic lesions were 100%,but the sensitivity of ME-NBI was superior to that of WLI with Lugol＇s staining（ 90. 0% vs. 70. 0%,p〈0. 05）. The agreement of ME-NBIguided targeted biopsy with definite pathological diagnosis was slightly higher than that of random biopsy by WLI with Lugol＇s staining（ 89. 7% vs. 86. 8%,p〉0. 05）. Conclusions： ME-NBI-guided targeted biopsy is superior to random b