窄带成像技术诊断早期食管癌的临床价值
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摘要
目的探讨窄带成像技术(NBI)诊断早期食管癌的临床价值。
方法收集96例常规内镜观察下有食管黏膜粗糙、糜烂、斑块、颜色异常、微隆起或凹陷等改变的患者及10例健康体检者,按普通内镜、内镜窄带技术(NBI)、内镜卢戈氏碘染色加放大技术的顺序进行观察,评价各种检查方法图象的清晰度;操作医师对NBI下观察到的上皮乳头内毛细血管袢(intrapapillary capillary loop,IPCL)进行分型,于改变最显著部位取活检进行病理检查,将内镜结果和组织病理结果对照研究后,进行统计学分析。
结果(1)纳入检查标准的96例患者中,经病理证实检出早期食管癌12例,食管慢性炎症30例,其他良性病变54例;(2)在观察早期食管癌的病变轮廓清晰度方面,NBI与染色内镜之间无统计学差异,但二者均显著优于普通内镜;在对食管黏膜IPCL形态结构的观察中,NBI放大内镜明显优于普通放大内镜;(3)90%(9/10)健康体检者符合IPCLⅠ型改变,86.7%(26/30)食管炎患者符合IPCLⅡ型改变,91.7%(11/12)的早期食管癌患者符合IPCLⅢ型和Ⅳ型改变,早期食管癌组与健康体检组(X~2=20.70,P＜0.005)、食管炎组比较(X~2=32.48,P＜0.005),食管炎组与健康体检组(X~2=26.14,P＜0.005)比较,均有统计学差异;黏膜癌组与黏膜下癌组比较亦有统计学差异。
结论NBI是一种新型的内镜检查系统,不仅操作简单,对早期食管癌病变的轮廓显示清晰,更可清晰地观察到IPCL结构形态,IPCL形态结构的变化不仅与组织学诊断密切相关,且有助于判断癌变浸润深度。
Objective To evaluate the narrow-band imaging endoscopy(NBI) in the diagnosis of early esophageal cancer.
Methods 96 patients with esophageal mucosa roughness,erosion, plaque,abnormal color and indentation in conventional endoscopy and 10 cases of physical persons were erolled.The esophagus was examined by the conventional endoscopy,NBI endoscopy,NBI combinded with magnifying endoscopy and Chromoendoscopy(Lugol's iodine staining).Then we carefully observed the outline of lesions and the intrapapillary capillary loop(IPCL) and evaluated the image clarity.The biopsies underwent pathologic evaluation.The comparion between the endoscopic findings and histological results was evaluated.
Results(1) The pathologic diagnosis of all the patients showed that there were 30 esophagitis,12 early esophageal carcinoma and 54 other diseases.(2)Visualization of esophageal cancer's lesions by NBI endoscopy and Chromoendoscopy were clearer than the conventional endoscopy.And there was no significant difference between NBI endoscopy and Chromoendoscopy.Visualization of IPCL by NBI combinded with magnifying endoscopy was clearer than the magnifying endoscopy.(3) 90%normal people was typeⅠ,86.7%(26/30) esophagitis was typeⅡ,and 91.7%(11/12) early esophageal carcinoma was typeⅢand typeⅣ.The difference was significant between early esophageal carcinoma and normal mucosa(X~2=20.70,P＜0.005),and between early esophageal carcinoma and esophagitis(X~2=32.48,P＜0.005).There was also a significant difference between the esophagitis and normal mucosa (X~2=26.14,P＜0.005),and between mucosal carcinoma and submucosal carcinoma.
Conclusion As a novel endoscopic system,NBI is very esay to operate,and it can not only capture the optimal images of the early esophageal carcinoma's lesions,but also show the IPCL.The IPCL is closely related to the histological results.Also the IPCL can help us determine the invasion depth of the cancer.
方法收集96例常规内镜观察下有食管黏膜粗糙、糜烂、斑块、颜色异常、微隆起或凹陷等改变的患者及10例健康体检者,按普通内镜、内镜窄带技术(NBI)、内镜卢戈氏碘染色加放大技术的顺序进行观察,评价各种检查方法图象的清晰度;操作医师对NBI下观察到的上皮乳头内毛细血管袢(intrapapillary capillary loop,IPCL)进行分型,于改变最显著部位取活检进行病理检查,将内镜结果和组织病理结果对照研究后,进行统计学分析。
结果(1)纳入检查标准的96例患者中,经病理证实检出早期食管癌12例,食管慢性炎症30例,其他良性病变54例;(2)在观察早期食管癌的病变轮廓清晰度方面,NBI与染色内镜之间无统计学差异,但二者均显著优于普通内镜;在对食管黏膜IPCL形态结构的观察中,NBI放大内镜明显优于普通放大内镜;(3)90%(9/10)健康体检者符合IPCLⅠ型改变,86.7%(26/30)食管炎患者符合IPCLⅡ型改变,91.7%(11/12)的早期食管癌患者符合IPCLⅢ型和Ⅳ型改变,早期食管癌组与健康体检组(X~2=20.70,P＜0.005)、食管炎组比较(X~2=32.48,P＜0.005),食管炎组与健康体检组(X~2=26.14,P＜0.005)比较,均有统计学差异;黏膜癌组与黏膜下癌组比较亦有统计学差异。
结论NBI是一种新型的内镜检查系统,不仅操作简单,对早期食管癌病变的轮廓显示清晰,更可清晰地观察到IPCL结构形态,IPCL形态结构的变化不仅与组织学诊断密切相关,且有助于判断癌变浸润深度。
Objective To evaluate the narrow-band imaging endoscopy(NBI) in the diagnosis of early esophageal cancer.
Methods 96 patients with esophageal mucosa roughness,erosion, plaque,abnormal color and indentation in conventional endoscopy and 10 cases of physical persons were erolled.The esophagus was examined by the conventional endoscopy,NBI endoscopy,NBI combinded with magnifying endoscopy and Chromoendoscopy(Lugol's iodine staining).Then we carefully observed the outline of lesions and the intrapapillary capillary loop(IPCL) and evaluated the image clarity.The biopsies underwent pathologic evaluation.The comparion between the endoscopic findings and histological results was evaluated.
Results(1) The pathologic diagnosis of all the patients showed that there were 30 esophagitis,12 early esophageal carcinoma and 54 other diseases.(2)Visualization of esophageal cancer's lesions by NBI endoscopy and Chromoendoscopy were clearer than the conventional endoscopy.And there was no significant difference between NBI endoscopy and Chromoendoscopy.Visualization of IPCL by NBI combinded with magnifying endoscopy was clearer than the magnifying endoscopy.(3) 90%normal people was typeⅠ,86.7%(26/30) esophagitis was typeⅡ,and 91.7%(11/12) early esophageal carcinoma was typeⅢand typeⅣ.The difference was significant between early esophageal carcinoma and normal mucosa(X~2=20.70,P＜0.005),and between early esophageal carcinoma and esophagitis(X~2=32.48,P＜0.005).There was also a significant difference between the esophagitis and normal mucosa (X~2=26.14,P＜0.005),and between mucosal carcinoma and submucosal carcinoma.
Conclusion As a novel endoscopic system,NBI is very esay to operate,and it can not only capture the optimal images of the early esophageal carcinoma's lesions,but also show the IPCL.The IPCL is closely related to the histological results.Also the IPCL can help us determine the invasion depth of the cancer.
引文
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