Narrow band imaging versus lugol chromoendoscopy to diagnose squamous cell carcinoma of the esophagus: a systematic review and meta-analysis.
Narrow band imaging versus lugol chromoendoscopy to diagnose squamous cell carcinoma of the esophagus: a systematic review and meta-analysis.
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DOI：
10.1186/s12885-016-3011-9
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发表时间：
2017-01-13
期刊：
影响因子：
3.8
通讯作者：
de Moura EG
中科院分区：
文献类型：
--
作者：
Morita FH;Bernardo WM;Ide E;Rocha RS;Aquino JC;Minata MK;Yamazaki K;Marques SB;Sakai P;de Moura EG
在早期食管癌中，粘膜的变化是微妙的，并且在使用白色光的内窥镜检查中未被注意到。为了提高灵敏度，使用了卢戈溶液的比色法。技术进步导致了内窥镜染色的虚拟方法的出现，包括窄带成像（NBI）。NBI增强了粘膜和底层血管模式的缓解，提供了更大的便利性，而没有使用活体染料的固有风险。本系统综述和荟萃分析的目的是评价NBI诊断食管鳞状细胞癌的能力，并将其与Lugol溶液染色镜检进行比较。该系统性综述包括比较NBI和Lugol染色内镜诊断食管高度异型增生和/或鳞状细胞癌准确性的所有研究。在荟萃分析中，我们计算并证明了敏感性，特异性，积极和消极的似然值在森林图。我们还确定了受试者工作特征（sROC）曲线，并估计了每个患者和每个病变分析的曲线下面积。初步检索识别出7079篇文章。其中，18项研究纳入系统综述，12项用于荟萃分析，共计1911例患者。在每例患者和每处病变分析中，Lugol染色内镜的敏感性、特异性、阳性和阴性似然值分别为92%和98、82和37%、5.42和1.4、0.13和0.39，NBI分别为88和94%、88和65%、8.32和2.62、0.16和0.12，分别只有特异性值存在统计学显著差异，在这种情况下，NBI在两项分析中均优于Lugol色素内镜。在按患者分析中，Lugol染色内镜的sROC曲线下面积为0.9559。在NBI的情况下，该数值为0.9611;在每病变分析中，该数值分别为0.9685和0.9587。NBI在评估食管以诊断高度异型增生和鳞状细胞癌方面是足够的。在这些疾病与其他食管粘膜病变的鉴别中，NBI显示出比Lugol更上级。
In the early stage esophageal cancer, changes in the mucosa are subtle and pass unnoticed in endoscopic examinations using white light. To increase sensitivity, chromoscopy with Lugol’s solution has been used. Technological advancements have led to the emergence of virtual methods of endoscopic chromoscopy, including narrow band imaging (NBI). NBI enhances the relief of the mucosa and the underlying vascular pattern, providing greater convenience without the risks inherent to the use of vital dye. The purpose of this systematic review and meta-analysis was to evaluate the ability of NBI to diagnose squamous cell carcinoma of the esophagus and to compare it to chromoscopy with Lugol’s solution. This systematic review included all studies comparing the diagnostic accuracy of NBI and Lugol chromoendoscopy performed to identify high-grade dysplasia and/or squamous cell carcinoma in the esophagus. In the meta-analysis, we calculated and demonstrated sensitivity, specificity, and positive and negative likelihood values in forest plots. We also determined summary receiver operating characteristic (sROC) curves and estimates of the areas under the curves for both per-patient and per-lesion analysis. The initial search identified 7079 articles. Of these, 18 studies were included in the systematic review and 12 were used in the meta-analysis, for a total of 1911 patients. In per-patient and per-lesion analysis, the sensitivity, specificity, and positive and negative likelihood values for Lugol chromoendoscopy were 92% and 98, 82 and 37%, 5.42 and 1.4, and 0.13 and 0.39, respectively, and for NBI were 88 and 94%, 88 and 65%, 8.32 and 2.62, and 0.16 and 0.12, respectively. There was a statistically significant difference in only specificity values, in which case NBI was superior to Lugol chromoendoscopy in both analyses. In the per-patient analysis, the area under the sROC curve for Lugol chromoendoscopy was 0.9559. In the case of NBI, this value was 0.9611; in the per-lesion analysis, this number was 0.9685 and 0.9587, respectively. NBI was adequate in evaluating the esophagus in order to diagnose high-grade dysplasia and squamous cell carcinoma. In the differentiation of those disorders from other esophageal mucosa alterations, the NBI was shown to be superior than Lugol.