窄带成像放大内镜在早期食管癌诊疗中的应用价值

摘要

目的 探讨窄带成像放大内镜(NBI-ME)在早期食管癌(食管早癌)或癌前病变定性诊断、定深度诊断和制定治疗策略方面的价值.方法 分析总结我院2013年7月至2017年2月收治的111例高度怀疑食管早癌或癌前病变且行内镜下黏膜剥离术(ESD)的病例,以术后组织病理结果为金标准,评价NBI-ME对食管早癌或癌前病变定性诊断、定深度诊断与术后病理结果的一致性及NBI-ME制定治疗策略的价值.结果 在定性诊断方面,111例病例中NBI-ME诊断为低级别上皮内瘤变(LGIN)者0例(其中术后组织病理结果为低级别上皮内瘤变、高级别上皮内瘤变、早癌分别为0例、0例、0例),诊断为高级别上皮内瘤变(HGIN)者33例(其中术后组织病理结果LGIN、HGIN、早癌分别为3例、30例、0例),诊断为早癌者78例(其中术后组织病理结果LGIN、HGIN、早癌分别为5例、22例、51例),NBI-ME与术后组织病理结果一致性分析:K=0.498,可认为NBI-ME与术后组织病理结果一致性一般.在定深度诊断方面,111例病例中诊断为LGIN者0例(其中术后组织病理结果LGIN、HGIN、黏膜内癌、黏膜下层癌分别为0例、0例、0例、0例),诊断为HGIN者33例(其中术后组织病理结果LGIN、HGIN、黏膜内癌、黏膜下层癌分别为3例、30例、0例、0例),诊断为黏膜内癌者67例(其中术后组织病理结果LGIN、HGIN、黏膜内癌、黏膜下层癌分别为5例、22例、30例、10例),诊断为黏膜下层癌者11例(其中术后组织病理结果LGIN、HGIN、黏膜内癌、黏膜下层癌分别为0例、0例、0例、11例),NBI-ME与术后组织病理结果一致性分析:K=0.469,可认为NBI-ME与术后组织病理结果一致性一般.在制定治疗策略方面,111例病例中除8例病理诊断为低级别上皮内瘤变者可选择随访外,其余病例均应行内镜下治疗.结论 NBI-ME食管早癌或癌前病变定性诊断和定深度诊断上具有一定的临床价值,对食管早癌或癌前病变治疗策略的选择具有指导价值.%Objective To explore the diagnosis value of narrow-band imaging magnifying endoscopy (NBI-ME) in the early esophageal cancer and precancerous lesions while estimating the quality,depth and treatment strategy.Methods One hundred and eleven cases of patients with suspected early esophageal cancer and precancerous lesions,who underwent ESD treatment,were selected as the study subjects.To estimate the diagnosis value of NBI-ME in the quality,depth and treatment strategy with pathological histology as gold standard.Results While estimating quality,there was no low grade intraepithelial neoplasia(LGIN) cases with NBI-ME.A total of 33 cases were diagnosed as high grade intraepithelial neoplasia(HGIN),including 30 cases of HGIN and 3 cases of LGIN after ESD treatment,and the other 78 cases were diagnosed as early esophageal cancer,including 5 cases of LGIN,22 cases of HGIN,and 51 cases of early esophageal cancer.Compared with the pathology results,the quality consistency of NBI-ME is general:K=0.498.While estimating depth,there was no LGIN cases with NBI-ME.A total of 33 cases were diagnosed as HGIN,including 30 cases of HGIN and 3 cases of LGIN after ESD treatment,67 cases were diagnosed as intramucosal carcinoma,including 5 cases of LGIN,22 cases of HGIN,30 cases of intramucosal carcinoma,and 10 cases of submucosal carcinoma after ESD treatment,and 11 cases were diagnosed as submucosal carcinoma.Compared with the pathology results,the depth consistency of NBI-ME is general:K=0.469.Most of the patients shoud be treated by ESD except 8 cases of LGIN.Conclusion The study shows general diagnosis value of NBI-ME in estimating quality,depth and treatment strategy of early esophageal cancer and precancerous lesions.