目的比较蓝激光成像放大内镜结合技术与窄带成像放大内镜技术对上消化道早癌的诊断价值。方法收集重庆医科大学附属第二医院2017年12月至2018年6月行普通白光内镜(white light endoscopy,WLE)筛查出的可疑上消化道早癌患者466例,共计病灶472处,其中227例采用蓝激光成像放大内镜技术(magnifying endoscopy with blue laser imaging,BLI-ME)、239例采用窄带成像放大内镜技术(magnifying endoscopy with narrowband imaging,NBI-ME)分别进行早癌精查,病检确诊及内镜下高度怀疑早癌的患者均行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD),最终以ESD术后病理为最高诊断。采用Kappa一致性检验评价BLI-ME、NBI-ME两种内镜诊断与病理诊断的一致性,比较两种检查技术对上消化道早癌的检出率、敏感度、特异度。结果病理结果显示炎症269处,萎缩或肠化生127处,低级别上皮内瘤变17处,早癌59处,存在食管多中心癌。BLI-ME、NBI-ME镜下诊断与病理诊断一致的病灶分别为85.2%、85.1%,Kappa值分别为0.756和0.759。BLI-ME、NBI-ME对诊断上消化道早癌的检出率分别为12.2%、12.8%;敏感度分别为89.3%、90.3%;特异度分别为97.0%、96.2%。BLI-ME、NBI-ME镜下诊断与早癌病理诊断一致的比例为96.1%和95.5%,Kappa值分别为0.810和0.825。结论 BLI-ME、NBI-ME对上消化道早癌的诊断价值较高,且二者的诊断价值相当。
Objective To compare the diagnostic performance of magnifying endoscopy with blue laser imaging(BLI-ME)versus narrowband imaging(NBI-ME)for early upper gastrointestinal cancer.Methods This study was carried out among 466 patients with suspected early upper gastrointestinal cancer(472 lesions)screened by conventional white light endoscopy(WLE).Among these patients,227 received subsequent examinations by BLI-ME and 239 were examined by NBI-ME.Endoscopic submucosal dissection(ESD)was performed in all the patients with confirmed cancers or highly suspected early cancer under endoscopy.The definite diagnoses were established according to the pathological results following ESD.The consistency between the endoscopic and pathological diagnoses was evaluated using Kappa agreement test,and the detection rate,sensitivity and specificity of the 2 techniques for diagnosis of early upper gastrointestinal cancer were analyzed.Results The pathological results confirmed 269 inflammatory lesions,127 lesions of atrophy or intestinal metaplasia,17 lesions of low-grade intraepithelial neoplasia,and 59 lesions of early cancers(with multicentric esophageal cancer).BLI-ME and NBI-ME had consistency rates of 85.2%and 85.1%with the pathological diagnoses,with Kappa values of 0.756 and 0.759,respectively.For early upper gastrointestinal cancer,the detection rates by BLI-ME and NBI-ME was 12.2%and 12.8%,respectively,and their diagnostic sensitivity was 89.3%and 90.3%with a diagnostic specificity of 97.0%and 96.2%,a consistency rate(with the pathological results)of 96.1%and 95.5%,and a Kappa value of 0.810 and 0.825,respectively.Conclusion Both BLI-ME and NBI-ME have high diagnostic value for upper gastrointestinal cancer with comparable diagnostic performances.
Journal of Third Military Medical University
white light endoscopy
narrow band imaging
blue laser imaging
early upper gastrointestinal cancer