醋酸染色后NBI内镜下大肠腺瘤和早期大肠癌的微形态特征

摘要

目的 分析醋酸染色后窄带成像(NBI)内镜下大肠腺瘤和早期大肠癌的黏膜表面腺管形态(pit)、微血管形态(cp)、黏膜白化时间的特征,评价其预测低级别上皮内瘤变、高级别上皮内瘤变和早期癌的价值.方法 用醋酸染色后NBI的方法观察大肠可疑病变,根据pit分型、cp分型、黏膜白化时间预测病变为低级别上皮内瘤变、高级别上皮内瘤变和早期癌,并与病理结果对照判断其敏感度、特异度、准确率、阳性预测值、阴性预测值.结果 入选106例病例.pit分型ⅢL或Ⅳ型,联合cp分型Ⅱ型和醋酸白化时间31~60 s预测低级别上皮内瘤变敏感度、特异度、准确率分别为87.2%、89.3%、87.7%;pit分型ⅤI型,联合cp分型ⅢA型和醋酸白化时间6~30 s预测高级别上皮内瘤变和早期癌的敏感度、特异度、准确率分别为82.1%、83.3%、83.0%.结论 醋酸染色后NBI观察大肠可疑病灶的微形态,两种方法结合,取长补短,能清晰显示病灶pit和cp,具有视野清晰、价格低廉、操作简单、无毒的优点,对鉴别低级别上皮内瘤变、高级别上皮内瘤变和早期癌有较高价值,值得推广应用.%Objective To analyze the characteristics of morphological (pit) , microvascular (cp) and mucosa whitening time in colorectal adenoma and early carcinoma under narrow band imaging (NBI) after acetic acid spray, and to evaluate the predictive ability on the low grade intraepithelial neoplasia, the high grade intraepithelial neoplasia and early carcinoma. Methods According to pit, cp and mucosa whitening time, NBI was used after acetic acid spray to observe colorectal suspicious lesions and forecast the low grade intraepithelial neoplasia, the high grade intraepithelial neoplasia and early carcinoma. Then compared with pathology results, their degree of sensitivity, specificity, accuracy, positive predictive value and negative predictive value were determined. Results 106 patients were enrolled. The pit type ⅢL or Ⅳ , cp type Ⅱ , and mucosa whitening time 31 ~ 60 s forecasted low grade intraepithelial neoplasia, the sensitivity, specificity and accuracy were 87.2% , 89. 3% and 87.7% respectively. The pit type ⅤI, cp type ⅢA and mucosa whitening time 6 ~ 30 s forecasted high grade intraepithelial neoplasia and early carcinoma, the sensitivity, specificity and accuracy were 82. 1% , 83. 3% and 83. 0% respectively. Conclusion NBI after acetic acid helps observed micro-morphology of colorectal suspicious lesions. It clearly shows lesion' s pit and cp have the vision clear by combining and complementing two ways. It has the advantages of cheapness, simpleness, non-toxin. In the differentiation of low grade intraepithelial neoplasia, high grade intraepithelial neoplasia and early cancers have higher value, worthy of replication.