Application of magnifying endoscopy with narrow-band imaging in diagnosing gastric lesions: a prospective study
Application of magnifying endoscopy with narrow-band imaging in diagnosing gastric lesions: a prospective study
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DOI：
10.1016/j.gie.2012.08.015
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发表时间：
2012-12-01
影响因子：
7.7
通讯作者：
Li, X-b.
中科院分区：
文献类型：
--
作者：
Li, H-y.;Dai, J.;Li, X-b.
背景资料：放大内镜窄带成像（ME-NBI）可以更清楚地评估胃病变的表面模式和微血管构筑。目的：评价ME-NBI对早期胃癌患者的诊断效果。设计：前瞻性研究。设置：单学术中心。患者：该研究涉及146名连续患者的164处疑似胃部病变，这些患者在治疗前接受了ME-NBI进行额外的鉴别诊断。ME-NBI结果根据不规则性、无表面图案和微血管结构分为3组。所有病变均经内镜或手术治疗，ME-NBI诊断与组织病理学结果进行比较。主要结果测量：灵敏度，特异性，阳性预测值，阴性预测值和实时ME-NBI诊断的准确性。ME-NBI鉴别癌性与非癌性病变的敏感性、特异性和准确性分别为97.3%、84.4%和90.2%;对未分化腺癌和分化腺癌的鉴别率分别为90.4%和90.4%。ME-NBI准确地预测了39个分化腺癌中的37个（95%）的浸润深度。局限性：样本量相对较小。结论：ME-NBI可以成功区分癌性和非癌性病变以及未分化和分化腺癌。在ME-NBI的3种模式中，A型主要是非癌性病变的特征，B型是分化腺癌和粘膜内/浅表浸润性癌症的良好指标，C型指示未分化腺癌或分化癌伴粘膜下深层浸润。（Gastrointest Endosc 2012;76：1124-32.）
Background: Magnifying endoscopy with narrow-band imaging (ME-NBI) can more clearly assess the surface pattern and microvascular architecture of gastric lesions.Objective: To evaluate the diagnostic efficacy of ME-NBI in patients with early gastric cancer.Design: Prospective study.Setting: Single academic center.Patients: This study involved 164 suspected gastric lesions in 146 consecutive patients who underwent ME-NBI for additional differential diagnosis before treatment.Intervention: ME-NBI findings were classified into 3 groups based on irregularities, absence of surface pattern, and microvascular architecture. All lesions were treated endoscopically or surgically, and ME-NBI diagnosis was compared with histopathological findings.Main Outcome Measurements: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of real-time ME-NBI diagnosis were determined.Results: The sensitivity, specificity, and accuracy of ME-NBI were 97.3%, 84.4%, and 90.2%, respectively, in distinguishing between cancerous and noncancerous lesions and were 92.3%, 89.7%, and 90.4%, respectively, in distinguishing undifferentiated from differentiated adenocarcinoma. ME-NBI accurately predicted depth of invasion in 37 of 39 differentiated adenocarcinomas (95%).Limitations: The sample size was relatively small.Conclusions: ME-NBI can successfully distinguish between cancerous and noncancerous lesions and between undifferentiated and differentiated adenocarcinomas. Of the 3 patterns on ME-NBI, type A is mainly characteristic of noncancerous lesions, type B is a good indicator of differentiated adenocarcinoma and intramucosal/superficially invasive cancers, and type C is indicative of undifferentiated adenocarcinoma or differentiated cancer with deep submucosal invasion. (Gastrointest Endosc 2012;76:1124-32.)