醋酸喷雾联合窄带成像对早期胃癌及癌前病变的诊断价值

中华消化内镜杂志 Pub Date : 2019-02-20 DOI:10.3760/CMA.J.ISSN.1007-5232.2019.02.003

Rong Wang, Chuanjie Deng, Jun Zhu, Xin Jiang, Guo-an Hua, Yingying Chen, Xiao-Yu Huang, Xiaodong Xu

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The image clarity, microsurface pattern, microvascular pattern, demarcation line, and mucosal whitening time were observed, and value of the 3 methods in diagnosis of early gastric cancer and precancerous lesions was analyzed. \n \n \nResults \nImage clarity of micro glandular in combination group was significantly better than that in NBI group and acetic acid spray group (χ2=8.766, P=0.003; χ2=5.273, P=0.022), and image clarity of microvascular in combination group was significantly better than that in NBI group (χ2=7.457, P=0.006). The overall diagnostic coincidence rate with pathology of combination group, NBI group, and acetic acid spray group was 91.9% (125/136), 85.3% (116/136), and 89.7% (122/136), respectively. The diagnostic sensitivity of irregular or missing microsurface, irregular or missing microvascular, obvious demarcation line, mucosal whitening time <30 s for carcinoma (including high grade intraepithelial neoplasia, early carcinoma and infiltrating carcinoma) were 92.3%, 91.3%, 92.3% and 90.4%, respectively, in the combination group, and the diagnostic specificity of above indicators were 93.8%, 93.8%, 96.9% and 90.6%, respectively, accuracy were 92.6%, 91.9%, 93.4% and 90.4%, respectively. For observation of microsurface, the combination group was superior to the NBI group (χ2=7.378, P=0.007), but there was no significant difference compared with the acetic acid spray group (χ2=0.427, P=0.513); the acetic acid spray group was superior to the NBI group (χ2=4.405, P=0.036). For observation of microvascular, the combination group was not significantly better than the NBI group (χ2=2.398, P=0.122). 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引用次数: 0

摘要

目的探讨醋酸喷雾联合窄带成像(NBI)对早期胃癌及癌前病变的诊断价值。方法选取2015年11月至2017年11月在上海市浦东新区光明中医院经内镜筛查发现的132例胃癌及癌前病变患者中的136例作为研究对象，分为NBI组、醋酸喷雾组、醋酸喷雾联合NBI组(联合组)。观察图像清晰度、微表面形态、微血管形态、分界线、黏膜增白时间，分析3种方法对早期胃癌及癌前病变的诊断价值。结果联合组微腺体图像清晰度明显优于NBI组和醋酸喷雾组(χ2=8.766, P=0.003;χ2=5.273, P=0.022)，联合组微血管图像清晰度明显优于NBI组(χ2=7.457, P=0.006)。联合组、NBI组和醋酸喷雾组的总体诊断符合率分别为91.9%(125/136)、85.3%(116/136)和89.7%(122/136)。联合组对癌(包括高级别上皮内瘤变、早期癌和浸润性癌)微表面不规则或缺失、微血管不规则或缺失、分界线明显、黏膜美白时间<30 s的诊断敏感性分别为92.3%、91.3%、92.3%和90.4%，上述指标的诊断特异性分别为93.8%、93.8%、96.9%和90.6%，准确率分别为92.6%、91.9%、93.4%和90.4%。微表面观察方面，联合用药组优于NBI组(χ2=7.378, P=0.007)，与醋酸喷雾组比较差异无统计学意义(χ2=0.427, P=0.513);醋酸喷雾组优于NBI组(χ2=4.405, P=0.036)。在微血管观察方面，联合用药组无明显优于NBI组(χ2=2.398, P=0.122)。观察分界线，联合用药组疗效不优于NBI组(χ2=2.722, P=0.099)和醋酸喷雾组(χ2=0.216, P=0.642)。醋酸喷雾组与NBI组在分界线观察上差异无统计学意义(χ2=1.433, P=0.231)。结论醋酸喷雾联合NBI与病理结果一致性好，诊断敏感性和特异性高，与单一NBI相比，能清晰显示早期胃癌及癌前病变的微表面。关键词:诊断;醋酸，染色;窄带成像;早期胃癌;癌前病变

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Diagnostic value of acetic acid spray combined with narrow-band imaging for early gastric cancer and precancerous lesion

Objective To evaluate the diagnostic value of acetic acid spray combined with narrow-band imaging (NBI) for early gastric cancer and precancerous lesion. Methods A total of 136 gastric cancers and precancerous lesions from 132 patients detected by screening endoscopy from November 2015 to November 2017 in Guangming Chinese Medicine Hospital of Pudong New Area, Shanghai were enrolled in this study, and were divided into NBI group, acetic acid spray group, and acetic acid spray combined with NBI group (combination group). The image clarity, microsurface pattern, microvascular pattern, demarcation line, and mucosal whitening time were observed, and value of the 3 methods in diagnosis of early gastric cancer and precancerous lesions was analyzed. Results Image clarity of micro glandular in combination group was significantly better than that in NBI group and acetic acid spray group (χ2=8.766, P=0.003; χ2=5.273, P=0.022), and image clarity of microvascular in combination group was significantly better than that in NBI group (χ2=7.457, P=0.006). The overall diagnostic coincidence rate with pathology of combination group, NBI group, and acetic acid spray group was 91.9% (125/136), 85.3% (116/136), and 89.7% (122/136), respectively. The diagnostic sensitivity of irregular or missing microsurface, irregular or missing microvascular, obvious demarcation line, mucosal whitening time <30 s for carcinoma (including high grade intraepithelial neoplasia, early carcinoma and infiltrating carcinoma) were 92.3%, 91.3%, 92.3% and 90.4%, respectively, in the combination group, and the diagnostic specificity of above indicators were 93.8%, 93.8%, 96.9% and 90.6%, respectively, accuracy were 92.6%, 91.9%, 93.4% and 90.4%, respectively. For observation of microsurface, the combination group was superior to the NBI group (χ2=7.378, P=0.007), but there was no significant difference compared with the acetic acid spray group (χ2=0.427, P=0.513); the acetic acid spray group was superior to the NBI group (χ2=4.405, P=0.036). For observation of microvascular, the combination group was not significantly better than the NBI group (χ2=2.398, P=0.122). For observation of demarcation line, the combination group was not significantly better than the NBI group (χ2=2.722, P=0.099) and the acetic acid spray group (χ2=0.216, P=0.642). There was no difference between the acetic acid spray group and the NBI group (χ2=1.433, P=0.231) in observation of demarcation line. Conclusion Acetic acid spray combined with NBI has a good consistency with pathological results with high diagnostic sensitivity and specificity, and can clearly show microsurface of early gastric cancers and precancerous lesions compared to single NBI. Key words: Diagnosis; Acetic acid, staining; Narrow-band imaging; Early gastric cancer; Precancerous lesions

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来源期刊

中华消化内镜杂志

CiteScore

0.10

自引率

0.00%

发文量

7555

期刊介绍： Chinese Journal of Digestive Endoscopy is a high-level medical academic journal specializing in digestive endoscopy, which was renamed Chinese Journal of Digestive Endoscopy in August 1996 from Endoscopy. Chinese Journal of Digestive Endoscopy mainly reports the leading scientific research results of esophagoscopy, gastroscopy, duodenoscopy, choledochoscopy, laparoscopy, colorectoscopy, small enteroscopy, sigmoidoscopy, etc. and the progress of their equipments and technologies at home and abroad, as well as the clinical diagnosis and treatment experience. The main columns are: treatises, abstracts of treatises, clinical reports, technical exchanges, special case reports and endoscopic complications. The target readers are digestive system diseases and digestive endoscopy workers who are engaged in medical treatment, teaching and scientific research. Chinese Journal of Digestive Endoscopy has been indexed by ISTIC, PKU, CSAD, WPRIM.