Enhanced magnifying endoscopy for differential diagnosis of superficial gastric lesions identified with white-light endoscopy
Enhanced magnifying endoscopy for differential diagnosis of superficial gastric lesions identified with white-light endoscopy
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DOI：
10.1007/s10120-013-0250-1
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发表时间：
2014-01-01
期刊：
影响因子：
7.4
通讯作者：
Qian Jia-ming
中科院分区：
文献类型：
--
作者：
Guo Tao;Lu Xing-hua;Qian Jia-ming
各种技术使用放大内镜（ME）和色素内镜正在开发，以提高图像的胃肠道肿瘤。本研究的目的是评价乙酸-靛胭脂混合物增强ME（ME-AIM）和窄带成像增强ME（ME-NBI）对传统白光内镜（WLE）发现的浅表胃病变的鉴别诊断能力。ME-NBI和ME-AIM用于进一步表征病变。病变的所有图像均由四名对临床数据不知情的熟练内镜医师进行评价。根据“VS分类”系统对508例患者（男性316例，女性192例;平均年龄63岁）共643个病灶（平均直径7 mm）进行了评估。643个病灶中24个经病理诊断为胃癌，其余均为非癌性病变。对于胃癌的诊断，三种放大结果（不规则微血管模式、不规则微表面模式和分界线）中的每一种的阴性预测值都很高（接近100%）。根据“VS分类”系统，ME-NBI或ME-AIM的特异性较高（99.5%或99.4% vs. 89.5%，P < 0.001）和准确性（99.2%或98.9%对89.0%，P < 0.001），ME-AIM与ME-NBI相比，对早期胃癌的鉴别诊断并不具有上级优势，而增强ME对早期胃癌的诊断有一定的价值，ME-NBI与ME-AIM相比，是一种更可行、更有效的方法。
Various techniques using magnifying endoscopy (ME) and chromoendoscopy are being developed to enhance images of gastrointestinal tumor. The aim of this study was to evaluate the diagnostic performance of ME enhanced by acetic acid-indigo carmine mixture (ME-AIM) and ME enhanced with narrow-band imaging (ME-NBI) for differential diagnosis of superficial gastric lesions identified with conventional white-light endoscopy (WLE).Patients with superficial gastric lesions picked up with WLE were enrolled in the study. ME-NBI and ME-AIM were used to further characterize the lesions. All images of the lesions were evaluated by four skilled endoscopists blinded to the clinical data. The microarchitectural patterns in the lesions were analyzed with reference to the "VS classification" system.A total of 643 lesions (mean diameter, 7 mm) from 508 patients (316 men, 192 women; mean age, 63 years) were evaluated. Pathologically, 24 of the 643 lesions were diagnosed as gastric cancer; the others were noncancerous lesions. For diagnosis of gastric cancer, the negative predictive value of each of the three magnified findings (irregular microvascular pattern, irregular microsurface pattern, and demarcation line) was high (nearly 100 %). According to the "VS classification" system, either ME-NBI or ME-AIM had a higher specificity (99.5 % or 99.4 % vs. 89.5 %, P < 0.001) and accuracy (99.2 % or 98.9 % vs. 89.0 %, P < 0.001) than WLE, and ME-AIM was not superior to ME-NBI for identifying carcinoma.Enhanced ME is useful for correctly diagnosing early gastric cancer, and in contrast with ME-AIM, ME-NBI is a more feasible and efficient method for clinical practice.