放大内镜结合窄带成像（ME-NBI）在上消化道的临床应用研究

发布时间：2018-01-29 03:40

本文关键词： 食管肿瘤放大胃镜窄带成像巴雷特食管放大胃镜窄带成像食管胃癌消化系统放大胃镜窄带成像微血管密度　出处：《苏州大学》2015年博士论文　论文类型：学位论文

【摘要】：目的比较ME-NBI(magnifying endoscopy with narrow-band imaging,放大内镜结合窄带成像)靶向活检与白光染色内镜随机活检对诊断食管可疑浅表性病变的差异,探讨对食管可疑浅表性病变复查胃镜时,应用ME-NBI指导靶向活检的价值。方法2013.01~2015.01,普通白光内镜(white light imaging:WLI)检查发现食管浅表性可疑肿瘤性病变65例,采用配对交叉设计分两组。A组:先白光胃镜+随机活检。4-6周后ME-NBI+靶向活检。B组:先ME-NBI+靶向活检,4-6周后白光胃镜+随机活检。WLI观察基础上进行卢戈氏液染色,并取活检。ME-NBI观察食管病变后,以井上(Inoue)IPCL(intraepithelial papillary capillary loop上皮内乳头状毛细血管袢)分型为标准,指导靶向活检。以两种观察模式下图像特征及活检结果为观察指标,对比与病理金标准的差异。结果最终有58例患者完成整个研究,其中男38例,年龄24~82岁,平均55.6±13.3岁;女20例,27~74岁,平均54.7±11.3岁。58例患者共发现病变74处,其中68处病变作为研究对象。WLI随机活检诊断肿瘤性病变的Se(Sensitivity,灵敏度)为70%,Sp(specificity,特异性)为100%,PPV(positive predict value,阳性预测值)为100%,NPV(negative predict value,阴性预测值)为95.1%。ME-NBI靶向活检诊断肿瘤性病变的Se为90%,Sp为100%,PPV为100%,NPV为98.3%。ME-NBI指导的靶向活检诊断肿瘤性病变较WLI具有更高的Se,差异具有统计学意义(P0.05)。WLI平均活检数量较ME-NBI更多(3.7块/例VS 2.2块/例,P0.05)。结论对食管浅表肿瘤性病变,ME-NBI比WLI具有更高的诊断准确性,ME-NBI指导下的靶向活检有助于减少活检数量。目的对比Barrett食管随访中,放大内镜(magnifying endoscopy,ME)结合窄带成像(narrow-band imaging,NBI)指导的靶向活检与单纯白光内镜(WLI)的四象限活检的准确性,以评价在Barrett食管的随访监测中应用ME-NBI指导靶向活检的价值。方法2012.09~2015.05,对经普通白光内镜(WLI)及活检病理诊断为Barrett食管的患者共96例,采用配对交叉设计,通过计算机软件随机决定先行WLI观察或ME-NBI观察,1-3月后换另一种方法观察。分析两种模式内镜图像特征及其检查结果与病理金标准的关系,对比活检的平均数量。结果共有88例患者完成整个研究。男56例,平均年龄52.4±12.0岁;女32例,平均年龄51.7±13.3岁。WLI检出LGIN(Low grade intraepithelial neoplasia,低级别上皮内瘤变)16例,HGIN(High grade intraepithelial neoplasia,高级别上皮内瘤变)3例,上皮内瘤变的总检出率:21.6%,诊断准确性为:88.6%。WLI检出肠上皮化生(specialized intestinal metaplasia,SIM)81例,检出率为:92.2%。ME-NBI检出LGIN23例,HGIN 5例。上皮内瘤变的总检出率:31.8%,诊断准确性为:98.8%。ME-NBI检出SIM 81例,检出率为:92.0%。ME-NBI在Barrett食管的随访中,检出的上皮内瘤变较WLI为高(31.8%VS21.6%,P0.05),诊断准确性ME-NBI较WLI为高,差异存在统计学意义(88.6%vs 98.8%,P0.05)。结论在Barrett食管的随访检测中,ME-NBI较WLI具有更高的上皮内瘤变检出率,而且所需活检数量更少。目的评估RVS(reform vessel-plus-surface classification,改良的VS分类)系统对胃早期肿瘤性病变的诊断价值。方法2012年09月至2015年05月,经WLI观察,诊断胃内存在可疑浅表型肿瘤性病变的患者124例。其中男87例、年龄40~83岁,平均63.2±7.9岁,女37例,年龄46~77岁,平均62.6±8.2岁。30例健康体检的志愿者作为对照。所有入组的患者进行胃镜精查,先WLI观察,然后行ME-NBI观察,记录WLI、ME-NBI下VS(vessel plus surface classification)分型、RVS分型特征,以RVS分型为标准靶向活检。依据病变形态特征、内镜活检病理,行ESD(Endoscopic Submucosal Dissection内镜粘膜下层剥离术)或手术治疗。切除标本采用免疫组化方法检测Ki67表达及MVD(microvessel density,微血管密度)计数。分析不同性质组织中Ki67的表达、MVD计数的差别,对比WLI、VS分型、RVS分型与最终病理结果的关系。结果本研究共完成118例患者的内镜精查,观察病变162处,其中161处病变纳入统计分析。其中LGIN 84处,HGIN 63处,粘膜内癌7处,SM1(粘膜下上1/3)癌5处,SM2-3癌(粘膜下2/3)2处。胃早期肿瘤性病变中,凹陷性(IIc、III)病变占57.1%;DL(Demarcation line,边界线)、不规则的表面腺管(Irregular microsurface pattern,IS)、不规则的粘膜微血管(Irregular microvascular pattern,IV)、腺管密度、粘膜微血管密度5项指标在非肿瘤性病变与肿瘤性病变中出现的频率不同(P0.05)。与对照组相比,Ki67在LGIN、HGIN、EGC(early gastric cancer,早期胃癌)中的表达升高,存在统计学意义(P0.05)。HGIN、EGC中Ki67的表达较癌旁及HGIN升高具有统计学意义(P0.05)。与对照组相比,存在粘膜异型的组织(LGIN、HGIN、EGC)中,MVD均存在升高(P0.05),LGIN、癌旁组织中的MVD与EGC组相比降低具有统计学意义(P0.05)。肿瘤性病变与周围正常组织的腺管间质距离比值(Intervening part,IP比值)为:1.57。非肿瘤性病变与周围正常组织的腺管间质距离比值(IP比值)为:1.05。肿瘤性病变IP比值较非肿瘤性病变IP比值增大具有统计学意义(P0.01)。WLI诊断EGC的Se为89.6%、Sp为61.9%。ROC曲线下面积0.84。ME-NBI诊断EGC的Se为94.8%、Sp为83.3%,ROC曲线下面积0.93。ME-NBI诊断EGC的准确性较WLI高,差异存在统计学意义(P0.01)。VS分型诊断EGC的Se为90.9%、Sp为81.0%,ROC曲线下面积:0.89。RVS分型诊断EGC的Se为94.8%、SP为83.3%,ROC曲线下面积0.93。两组相比RVS分型诊断EGC的Se较VS分型升高,具有统计学意义(P0.01)。结论早期胃肿瘤性病变细胞增殖活跃,Ki67表达明显升高,MVD升高。ME-NBI下腺管密度、微血管密度可作为病变性质判断的指标。RVS分型对胃浅表型病变具有较高的诊断准确性,值得临床进一步推广。与WLI相比,ME-NBI对胃浅表型肿瘤性病变具有更高的诊断准确性。
[Abstract]:Objective to compare the ME-NBI (magnifying endoscopy with narrow-band imaging, magnifying endoscopy combined with narrow band imaging) target biopsy and white light staining differences between endoscopic biopsy in the diagnosis of suspicious random esophageal superficial lesions, to explore the suspicious esophageal superficial lesions by gastroscopy, application of ME-NBI guide targeted biopsy. Methods conventional endoscopy (2013.01~2015.01 white light imaging:WLI) findings of superficial esophageal suspicious tumors in 65 cases, using the paired crossover design was divided into two groups: the first group.A white light endoscopy + random biopsy after.4-6 weeks ME-NBI+ target biopsy group.B: first ME-NBI+ targeted biopsy, after 4-6 weeks of white light endoscopy + biopsy.WLI random observation based on Lugo staining, and to observe the esophageal lesion biopsy after.ME-NBI to wells (Inoue) IPCL (intraepithelial papillary capillary loop intraepithelial papillary capillary loop) classification standard Standard guide targeted biopsy. In two observation mode image features and biopsy results as observation indexes, the difference compared with the gold standard. The results of the final pathology of 58 patients completed the trial, including 38 cases of male, aged 24~82 years old, average 55.6 + 13.3 years; 20 were female, 27~74 years old, an average of 54.7 11.3.58 patients were found in 74 lesions, including 68 lesions as the research object of.WLI random biopsy in the diagnosis of neoplastic lesions (Se Sensitivity, 70%, Sp (sensitivity) of specificity, the specificity was 100% (positive), PPV predict value, the positive predictive value was 100% (negative), NPV predict value the negative predictive value was 95.1%.ME-NBI), targeted biopsy in the diagnosis of neoplastic lesions of the Se 90%, Sp 100%, PPV 100%, NPV 98.3%.ME-NBI guided targeted biopsy in the diagnosis of neoplastic lesions than WLI has a higher Se, the difference was statistically significant (P0.05) the average number of.WLI biopsy than ME -NBI (3.7 / 2.2 / VS, P0.05). The conclusion of superficial esophageal lesions, ME-NBI has a higher diagnostic accuracy than WLI, under the guidance of ME-NBI targeted biopsy can help reduce the number of biopsy. To compare the Barrett of esophageal follow-up, magnifying endoscopy (magnifying endoscopy ME) combined with narrow band imaging (narrow-band imaging NBI) target biopsy with simple white light endoscopy guidance (WLI) the accuracy of four quadrant biopsy, to evaluate the follow-up monitoring in Barrett's esophagus in the application of ME-NBI for targeted biopsy. Methods 2012.09~2015.05 by conventional endoscopy (WLI) and biopsy for the diagnosis of Barrett's esophagus a total of 96 patients with paired crossover design, through the computer software WLI ME-NBI randomly decided to advance observation or observation, observation of another method for 1-3 months. Two models of image features and endoscopic findings and pathological The relationship between the gold standard, the average number of contrast biopsy. Results: a total of 88 patients completed the trial. 56 cases were male, mean age 52.4 + 12 years; 32 were female, mean age 51.7 + 13.3.WLI (Low grade intraepithelial neoplasia LGIN detection, low grade intraepithelial neoplasia in 16 cases, HGIN (High) grade intraepithelial neoplasia, high grade intraepithelial neoplasia) 3 cases of intraepithelial neoplasia: the total detection rate of 21.6%, the diagnostic accuracy for 88.6%.WLI detection of intestinal metaplasia (specialized intestinal, metaplasia, SIM) in 81 cases, the detection rate of 92.2%.ME-NBI LGIN23 positive cases, 5 cases of HGIN. The total intraepithelial neoplasia the detection rate of 31.8%, the diagnostic accuracy was: 98.8%.ME-NBI SIM was detected in 81 cases, the detection rate of 92.0%.ME-NBI in Barrett's esophagus during follow-up, the detection of intraepithelial neoplasia is higher than WLI (31.8%VS21.6%, P0.05), the diagnostic accuracy of ME-NBI was higher than WLI, the difference had statistical meaning Yi (88.6%vs 98.8%, P0.05). Conclusion in Barrett's esophagus were detected in ME-NBI, WLI has a higher detection rate of intraepithelial neoplasia, and required fewer biopsies. Objective: To evaluate the RVS (reform vessel-plus-surface classification, the modified VS classification system) value in the diagnosis of gastric tumors. Methods in early 2012 09 to 2015 05 months, observed by WLI, 124 cases of patients with suspected superficial tumor diagnosis in the stomach. There were 87 male, aged 40~83 years old, average 63.2 + 7.9 years, 37 cases were female, aged 46~77 years old, average 62.6 + 8.2.30 healthy volunteers as control. All in the group of patients underwent gastroscopy exploration, WLI observation, and ME-NBI observation, record WLI, ME-NBI (VS vessel plus surface classification) classification, RVS classification with RVS classification standard targeted biopsy. According to the morphological characteristics, endoscopic biopsy disease Daniel, ESD (Endoscopic Submucosal Dissection endoscopic submucosal dissection) or surgery. Specimens by immunohistochemical method to detect the expression of Ki67 and MVD (microvessel density, microvessel density count). Expression of Ki67 in different tissues, MVD count difference, compared to WLI, VS type, RVS points type and final pathological results. Results of this study were carried out in 118 patients with endoscopic observation, 162 lesions, including 161 lesions were included in the statistical analysis. The LGIN 84, HGIN 63, intramucosal carcinoma 7, SM1 (submucous 1/3) cancer 5, SM2-3 cancer (submucosal 2/3 2). Early gastric neoplastic lesions in the depression (IIc, III) lesions accounted for 57.1%; DL (Demarcation line, the boundary line), irregular surface glandular tube (Irregular microsurface, pattern, IS), irregular mucosal microvessels (Irregular microvascular pattern, IV), gland density, viscosity 5 indicators of membrane microvessel density in tumor lesions and non neoplastic lesions in different frequencies (P0.05). Compared with the control group, Ki67 in LGIN, HGIN, EGC (early gastric cancer, elevated expression in early gastric cancer), there were statistical significance (P0.05.HGIN), the expression of EGC in Ki67 is cancer and HGIN increased with statistical significance (P0.05). Compared with the control group, there is abnormal tissue mucosa (LGIN, HGIN, EGC, MVD) were increased (P0.05), LGIN, MVD in cancer tissue was significant decreased compared with EGC group (P0.05). The tumor and the surrounding normal the interstitial gland distance ratio (Intervening part, IP: 1.57. ratio) for non neoplastic lesions and normal tissue around the gland interstitial distance ratio (IP ratio): 1.05. tumor IP ratio than the non neoplastic lesions was statistically significant increase of the ratio of IP (P0.01).WLI in the diagnosis of EGC Se is 89.6%, Sp is the area under the 61.9%.ROC curve of 0.84.ME-NBI in the diagnosis of EGC Se 94.8%, Sp 83.3%, 0.93.ME-NBI area under the ROC curve of the accuracy in the diagnosis of EGC was higher than WLI, the difference was statistically significant (P0.01) diagnosis of type.VS EGC Se 90.9%, Sp 81%, ROC area under the curve type: 0.89.RVS the diagnosis of EGC Se 94.8%, SP 83.3%, ROC area under the curve of 0.93. two group compared to the diagnosis of type RVS EGC Se is VS type increased, with statistical significance (P0.01). Conclusion the proliferation of early gastric tumor cell activity, Ki67 expression was significantly increased, MVD increased density of luminal.ME-NBI, diagnostic accuracy.RVS can be used as indicators of microvessel density lesions determine the nature of the type has higher superficial gastric lesions, it is worthy of further promotion. Compared with WLI, ME-NBI has a higher diagnostic accuracy of gastric superficial neoplastic lesions.

【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735

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