放大內(nèi)鏡結(jié)合窄帶成像在食管淺表性病變靶向活檢中的應(yīng)用價(jià)值*

王芳軍 劉鵬飛 趙 可 高 昳 劉兵團(tuán) 劉華敏

東南大學(xué)醫(yī)學(xué)院附屬江陰醫(yī)院消化內(nèi)科1(214400) 病理科2

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放大內(nèi)鏡結(jié)合窄帶成像在食管淺表性病變靶向活檢中的應(yīng)用價(jià)值*

王芳軍1#劉鵬飛1趙 可2高 昳1劉兵團(tuán)1劉華敏1

東南大學(xué)醫(yī)學(xué)院附屬江陰醫(yī)院消化內(nèi)科1(214400) 病理科2

背景：食管癌為常見消化道惡性腫瘤，早期診斷是改善預(yù)后的關(guān)鍵。因此，尋求提高早期食管癌內(nèi)鏡檢出率的方法具有重要臨床意義。目的：評(píng)價(jià)放大內(nèi)鏡結(jié)合窄帶成像(ME-NBI)指導(dǎo)的靶向活檢對(duì)食管可疑淺表性病變的診斷準(zhǔn)確性。方法：采用前瞻性交叉試驗(yàn)設(shè)計(jì)，納入常規(guī)胃鏡檢查發(fā)現(xiàn)食管存在可疑淺表性病變的患者65例，隨機(jī)進(jìn)入A組或B組。A組先行白光(WLI)染色內(nèi)鏡(Lugol液染色)+隨機(jī)活檢，4～6周后行ME-NBI+靶向活檢，B組反之。以井上上皮乳頭內(nèi)毛細(xì)血管襻(IPCL)分型為標(biāo)準(zhǔn)指導(dǎo)靶向活檢。結(jié)果：58例患者完成研究，68處病變可作為研究對(duì)象。WLI染色內(nèi)鏡平均活檢數(shù)量多于ME-NBI(3.7對(duì)2.2，P<0.05)。IPCL分型與最終病理結(jié)果的總體符合率為89.7%。ME-NBI靶向活檢與WLI染色內(nèi)鏡隨機(jī)活檢結(jié)果總體符合率為85.3%，兩者診斷腫瘤性病變的特異性和陽性預(yù)測值均為100%，敏感性ME-NBI優(yōu)于WLI染色內(nèi)鏡(90.0%對(duì)70.0%,P<0.05)，與最終病理結(jié)果的符合率亦略高于WLI染色內(nèi)鏡(89.7%對(duì)86.8%,P>0.05)。結(jié)論：對(duì)于食管淺表腫瘤性病變，ME-NBI指導(dǎo)的靶向活檢較WLI染色內(nèi)鏡隨機(jī)活檢具有更高的敏感性，且可減少活檢數(shù)量，有利于后續(xù)內(nèi)鏡治療。

食管腫瘤； 放大內(nèi)鏡； 窄帶成像； 靶向活檢； 診斷

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 (3.7vs. 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-NBI-guided 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 biopsy by WLI with Lugol’s staining for detection of superficial neoplastic lesions in esophagus with higher sensitivity and less number of biopsy. It might benefit the follow-up endoscopic treatment.

食管癌為常見消化道惡性腫瘤，目前其標(biāo)準(zhǔn)檢查方法為胃鏡和活檢病理檢查，但早期食管癌內(nèi)鏡下可僅有黏膜色澤改變、糜爛等輕微變化，常規(guī)胃鏡檢查中極易被遺漏，因此，尋求提高早期食管癌內(nèi)鏡檢出率的方法具有重要臨床意義。放大內(nèi)鏡(magnifying endoscopy, ME)是在常規(guī)白光(white light imaging, WLI)內(nèi)鏡的基礎(chǔ)上增加圖像放大功能，通過光學(xué)、電子放大突出顯示病變細(xì)節(jié)。……