NBI-ME对病变表面微血管分型在诊断结直肠早期肿瘤中的意义

摘要

目的 通过窄带成像放大内镜技术(NBI-ME)对结直肠病变表面微血管形态进行观察分型,研究NBI-ME对检出早期结直肠肿瘤性病变的价值.方法 肠镜检查发现新生性病变后,用NBI-ME模式观察病变表面微血管形态并进行分型,所有病变均在内镜下切除或手术切除,将NBI-ME判断病变的性质与病理诊断结果比较.结果 NBI-ME在2115例患者中发现新生性病变2778个,MP-0型诊断为炎性息肉的准确率为97.4％,MP-Ⅰ型诊断为增生性息肉的准确率为93.3％,MP-Ⅱ型诊断为管状腺瘤准确率为97.2％,MP-Ⅲ型诊断为绒毛状腺瘤准确率为98.3％,MP-Ⅳ型诊断为绒毛状-管状腺瘤准确率为94.5％,MP-V型诊断为高级别上皮内瘤变准确率为96.9％,MP-Ⅵ型诊断为黏膜内癌准确率为90.9％,MP-Ⅶ型诊断为浸润癌准确率为88.0％,MP-Ⅷ型诊断为进展期癌准确率为100.O％.NBI-ME对病变表面微血管形态判断肿瘤性病变的准确性为98.8％,敏感度为99.2％,特异性为94.9％.结论 NBI-ME内镜技术病变表面微血管形态分型,对判断病变是否是肿瘤性病变的准确率高,对早期结直肠肿瘤或结直肠癌的病理诊断预测准确率高,NBI-ME将成为发现结直肠早期肿瘤的更有效的内镜检查方法.%Objective To classify the microvascular patterns(MP) on the surface of colorectal lesion or tumor with the technique of Narrow Band Imaging combined with Magnifying Endoscopy ( NBI - ME) , and explore the potential clinical significance of MP classification in the early colorectal tumors diagnosis. Methods With NBI - ME technique, the MP on the surface of colorectal neogenesis lesions were recorded and classified. All of the neogenesis lesions were resected endoscopically or by surgery. The data achieved by NBI - ME were compared with histopathology diagnosis to assess the accuracy, sensitivity and specificity of NBI - ME on the early colorectal tumors diagnosis. Results A total of 2778 neogenesis lesions were detected in 2115 patients by NBI - ME,which were classified to 9 subtypes from type MP-0 to type MP - Ⅷ. Compared with histopathology diagnosis, we found 97.4% of MP-0 fall into inflammatory polyps. Moreover, 93.3% of MP - Ⅰ , 97.2% of MP - Ⅱ , 98.3% of MP - Ⅲ , 94.5% of MP - Ⅳ , 96.9% of MP - Ⅴ , 90.9% of MP - Ⅵ , 88.0% of MP - Ⅶ andl00.0% of MP - Ⅷ fall into proliferative polyps, tubular adenoma, villous adenoma, villous - tubular adenoma, high -grade adenoma, intramucosal carcinoma, slightly invaded submucosal cancer and advanced cancer respectively. Taken together, the accuracy, sensitivity, specificity of the microvascular patterns ( MP) by NBI - ME on the colorectal tumors diagnosis was 98. 8% , 99. 2% and 94. 9% respectively. Conclusion The diagnostic accuracy of MP classification by NBI - ME technique was significantly higher, it is a prospective strategy for early colorectal tumors.