放大内镜结合窄带成像对早期上消化道肿瘤诊断的临床相关研究
发布时间：2018-08-12 16:41
【摘要】：背景和目的上消化道恶性肿瘤主要指食管癌和胃癌,是新近发病率增长较快的恶性肿瘤,其发病率、死亡率居高不下均位于全球恶性肿瘤的前10名。上消化道肿瘤的预后与诊断的时机密切相关,早期诊断和早期治疗是其根治性治疗的关键,能够有效提高患者生存率及预后。放大内镜结合窄带成像(magnifying endoscopy with narrow-band imaging,ME-NBI)能够清楚显示消化道黏膜形态以及黏膜内血管结构,发现上消化道早期肿瘤出现的细微结构改变,有利于及时发现高级别上皮内瘤变等早期上消化道肿瘤性病变。本文主要探讨ME-NBI及其镜下分型对早期上消化道肿瘤及癌前病变的诊断价值和临床意义。资料和方法回顾性分析2015年1月至2017年1月于郑州大学第二附属医院消化内科病区住院且符合纳入标准的上消化道肿瘤及癌前病变患者共139例。早期食管癌及癌前病变患者79例,其中男性患者48例(60.76%),女性患者31例(39.24%),平均年龄61.92±9.64岁,共计病灶86处。早期胃癌(early gastric cancer,EGC)及癌前病变患者60例,男性患者46例(76.67%),女性患者14例(22.33%),平均年龄61.03±9.87岁,共计病灶63处。所有患者均行黏膜切除术(endoscopic mucosal resection,EMR)或黏膜下剥离术(endoscopic submucosal dissection,ESD),有完整的临床和病理资料,入选患者均自愿签署知情同意书。本文主要观察符合纳入标准的患者的年龄、性别、病变部位、内镜下巴黎分型、普通放大内镜(magnifying endoscopy,ME)及ME-NBI镜下的微结构形态和微血管形态、内镜下诊断结果和病理诊断结果。统计学分析早期上消化道肿瘤性疾病的病变部位、镜下形态,对比普通白光内镜(white light imaging,WLI)和ME-NBI观察病变部位、微结构和微血管形态的清晰度,比较内镜诊断结果和病理诊断结果的一致性,分析ME-NBI分型对上消化道肿瘤诊断的敏感性和特异性及比较微血管及表面结构分型(vessel plus surface classification,VS)和改良微血管及表面结构分型(Reform vessel-plus-surface classification,RVS)分型对EGC诊断的价值。结果早期食管癌及癌前病变患者内镜下最常见的形态为Type0-Ⅱ共计81处(94.19%),其中Type0-Ⅱb有58处(67.44%)。病理诊断早期食管肿瘤性病变共有64处(74.42%),内镜下最常见的形态为Type0-Ⅱ共计60处(93.75%),其中Type0-Ⅱb有39处(60.94%)。病变最常见的部位为胸中段有56处(65.12%)。患者的性别与食管病变部位间无统计学相关性(P0.05,P=0.32),而发病年龄与食管病变部位间有显著的相关性,中下段食管病变的发病年龄较上段提早约10年(P0.05,P=0.02)。NBI观察食管病变部位清晰度均显著高于WLI,差异具有统计学意(P0.001)。ME-NBI观察食管病变部位IPCL形态清晰度均显著高于ME,差异具有统计学意义(P0.001)。病理组织学证实的食管肿瘤性病变共有64处,内镜下诊断Ⅳ、Ⅴ1、Ⅴ2、Ⅴ3、ⅤN的共有67处,诊断早期食管肿瘤性疾病的敏感度、特异度、阳性预测值、阴性预测值分别为:89.06%、54.55%、85.07%、63.15%。运用KAPPA一致性检验判断内镜下诊断与术后病理诊断关系,KAPPA系数为0.47提示内镜下诊断与术后病理结果有较好的一致性,说明食管黏膜IPCL井上分型对早期食管肿瘤性病变具有良好的诊断价值。EGC及癌前病变患者内镜下最常见的形态是Type0-Ⅱ共计48处(76.19%),其中Type0-Ⅱc有20处(31.75%)。病理诊断胃部肿瘤性病变共计44处(69.84%),内镜下最常见的形态是Type0-Ⅱ共计33处(75%),其中Type0-Ⅱc有15处(34.09%)。病变最常见的部位为贲门和胃窦,分别有23处(36.51%)、22处(34.92%)。患者的性别和年龄与病变部位均无统计学相关性(P0.05)。NBI内镜观察胃病变部位清晰度均显著高于WLI,差异具有统计学意义(P0.05)。ME-NBI观察胃病变部位腺管开口形态和毛细血管结构形态清晰度均显著高于ME,差异具有统计学意义(P0.001)。RVS分型诊断EGC的敏感度和特异度分别为:“分界线”为100%、88.1%、“不规则的黏膜微血管”为85.71%、42.86%。“不规则的表面腺管”为80.95%、23.81%。“腺管密度增加”为71.43%、50%。“黏膜微血管密度增加”为57.14%、66.67%。KAPPA一致性检验判断内镜下诊断与术后病理诊断关系,KAPPA系数为0.86提示内镜下诊断与术后病理结果几乎完全一致,提示RVS分型对EGC有非常高的诊断价值。VS分型的AUC为0.92,RVS分型的AUC为0.91,均对EGC有很高的诊断价值。结论1.早期上消化道肿瘤及癌前病变内镜下最常见的形态为平坦型(Type0-Ⅱ),其中食管浅表平坦型(Type0-Ⅱb)常见,胃部浅表凹陷型(Type0-Ⅱc)多见。2.ME-NBI在对食管和胃部病变部位、微结构及微血管形态的观察比WLI和ME内镜更有优势。3.井上分型对早期食管肿瘤性疾病有良好的诊断预测价值,其内镜下诊断与术后病理结果有较好的一致性。4.RVS分型5项指标有助于胃肿瘤性病变与非肿瘤性病变的鉴别,RVS分型对EGC有很高的诊断价值。
[Abstract]:BACKGROUND AND OBJECTIVE Malignant tumors of the upper gastrointestinal tract mainly refer to esophageal cancer and gastric cancer, which are the fastest-growing malignant tumors in recent years. The incidence and mortality of these malignant tumors are among the top 10 in the world. Enlarged endoscopy combined with narrow-band imaging (ME-NBI) can clearly show the morphology of gastrointestinal mucosa and the vascular structure in the mucosa. Fine structural changes of early upper gastrointestinal tumors can be found, which is conducive to the timely detection of high-grade intraepithelial neoplasms. This article mainly discusses the diagnostic value and clinical significance of ME-NBI and its microscopic classification for early upper gastrointestinal neoplasms and precancerous lesions.Data and methods A retrospective analysis was made on the patients hospitalized in the Department of Gastroenterology, Second Affiliated Hospital of Zhengzhou University from January 2015 to January 2017 and the patients met the inclusion criteria. There were 139 patients with metastatic tumors and precancerous lesions. Among the 79 patients with early esophageal cancer and precancerous lesions, 48 (60.76%) were male, 31 (39.24%) were female, with an average age of 61.92 [9.64] years. There were 86 lesions. 60 patients with early gastric cancer (EGC) and precancerous lesions, 46 (76.67%) were male and 14 (22.67%) were female. All patients underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). All patients had complete clinical and pathological data and signed informed consent voluntarily. Age, sex, lesion location, endoscopic classification of Paris, microscopic and microvascular morphology under magnifying endoscopy (ME) and ME-NBI, endoscopic diagnosis and pathological diagnosis were performed. The lesion location and microscopic morphology of early upper gastrointestinal neoplasms were statistically analyzed and compared with those under general white light endoscopy (whit). E-light imaging, WLI and ME-NBI were used to observe the location, microstructure and microvascular morphology of lesions, to compare the consistency of endoscopic diagnosis and pathological diagnosis, to analyze the sensitivity and specificity of ME-NBI typing in the diagnosis of upper gastrointestinal tumors, and to compare vessel plus surface classification (VS) and its modification. Results 81 (94.19%) of the patients with early esophageal cancer and precancerous lesions had the most common endoscopic morphology of Type 0-II, 58 (67.44%) of which had Type 0-II B. 64 (74.42%) had early pathological diagnosis of esophageal neoplasms. The most common endoscopic appearance was Type 0-II in 60 lesions (93.75%), including Type 0-II in 39 lesions (60.94%). The most common lesion was in the middle thoracic segment in 56 lesions (65.12%). The onset age of esophageal lesions was 10 years earlier than that of upper esophageal lesions (P 0.05, P = 0.02). The intelligibility of esophageal lesions by NBI was significantly higher than that by WLI (P 0.001). The morphological intelligibility of IPCL by ME-NBI was significantly higher than that by ME (P 0.001). The sensitivity, specificity, positive predictive value and negative predictive value were 89.06%, 54.55%, 85.07% and 63.15% respectively. KAPPA consistency test was used to determine the relationship between endoscopic diagnosis and postoperative pathological diagnosis. The KAPPA coefficient was 0.47, indicating endoscopic diagnosis. The most common endoscopic morphology of EGC and precancerous lesions was Type 0-II in 48 (76.19%) patients, of which 20 (31.75%) were Type 0-II C. Pathological diagnosis of gastric neoplastic lesions was 44 (41.75%). 69.84%. The most common endoscopic morphology was Type 0-II in 33 (75%) sites, of which 15 (34.09%) were Type 0-II C. The most common lesions were cardia and antrum, 23 (36.51%) and 22 (34.92%) respectively. There was no significant correlation between gender and age and lesion site (P 0.05). In WLI, the difference was statistically significant (P 0.05). The difference was statistically significant (P 0.001). The sensitivity and specificity of RVS typing in diagnosis of EGC were 100%, 88.1% and 85.71% respectively. "Irregular surface glandular duct" was 80.95%, 23.81%. "Increase of glandular duct density" was 71.43%, 50%. "Increase of mucosal microvessel density" was 57.14%, 66.67%. KAPPA consistency test judged the relationship between endoscopic diagnosis and postoperative pathological diagnosis. KAPPA coefficient was 0.86, suggesting that endoscopic diagnosis and postoperative pathological results were almost identical, suggesting that R. VS typing has very high diagnostic value for EGC. AUC of VS typing is 0.92, and AUC of RVS typing is 0.91. Conclusion 1. The most common endoscopic appearance of early upper gastrointestinal neoplasms and precancerous lesions is flat type (Type 0-II). Esophageal superficial flat type (Type 0-II b) is common, and gastric superficial depression type (Type 0-II) is common. ME-NBI is more advantageous than WLI and ME in the observation of pathological location, microstructure and microvascular morphology of esophagus and stomach. 3. Well classification has a good diagnostic and predictive value for early esophageal neoplasms, and its endoscopic diagnosis and postoperative pathological results have a good consistency. 4. RVS classification of five indicators contribute to gastric neoplasms. RVS typing is of high diagnostic value for EGC.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735
本文编号：2179649
[Abstract]:BACKGROUND AND OBJECTIVE Malignant tumors of the upper gastrointestinal tract mainly refer to esophageal cancer and gastric cancer, which are the fastest-growing malignant tumors in recent years. The incidence and mortality of these malignant tumors are among the top 10 in the world. Enlarged endoscopy combined with narrow-band imaging (ME-NBI) can clearly show the morphology of gastrointestinal mucosa and the vascular structure in the mucosa. Fine structural changes of early upper gastrointestinal tumors can be found, which is conducive to the timely detection of high-grade intraepithelial neoplasms. This article mainly discusses the diagnostic value and clinical significance of ME-NBI and its microscopic classification for early upper gastrointestinal neoplasms and precancerous lesions.Data and methods A retrospective analysis was made on the patients hospitalized in the Department of Gastroenterology, Second Affiliated Hospital of Zhengzhou University from January 2015 to January 2017 and the patients met the inclusion criteria. There were 139 patients with metastatic tumors and precancerous lesions. Among the 79 patients with early esophageal cancer and precancerous lesions, 48 (60.76%) were male, 31 (39.24%) were female, with an average age of 61.92 [9.64] years. There were 86 lesions. 60 patients with early gastric cancer (EGC) and precancerous lesions, 46 (76.67%) were male and 14 (22.67%) were female. All patients underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). All patients had complete clinical and pathological data and signed informed consent voluntarily. Age, sex, lesion location, endoscopic classification of Paris, microscopic and microvascular morphology under magnifying endoscopy (ME) and ME-NBI, endoscopic diagnosis and pathological diagnosis were performed. The lesion location and microscopic morphology of early upper gastrointestinal neoplasms were statistically analyzed and compared with those under general white light endoscopy (whit). E-light imaging, WLI and ME-NBI were used to observe the location, microstructure and microvascular morphology of lesions, to compare the consistency of endoscopic diagnosis and pathological diagnosis, to analyze the sensitivity and specificity of ME-NBI typing in the diagnosis of upper gastrointestinal tumors, and to compare vessel plus surface classification (VS) and its modification. Results 81 (94.19%) of the patients with early esophageal cancer and precancerous lesions had the most common endoscopic morphology of Type 0-II, 58 (67.44%) of which had Type 0-II B. 64 (74.42%) had early pathological diagnosis of esophageal neoplasms. The most common endoscopic appearance was Type 0-II in 60 lesions (93.75%), including Type 0-II in 39 lesions (60.94%). The most common lesion was in the middle thoracic segment in 56 lesions (65.12%). The onset age of esophageal lesions was 10 years earlier than that of upper esophageal lesions (P 0.05, P = 0.02). The intelligibility of esophageal lesions by NBI was significantly higher than that by WLI (P 0.001). The morphological intelligibility of IPCL by ME-NBI was significantly higher than that by ME (P 0.001). The sensitivity, specificity, positive predictive value and negative predictive value were 89.06%, 54.55%, 85.07% and 63.15% respectively. KAPPA consistency test was used to determine the relationship between endoscopic diagnosis and postoperative pathological diagnosis. The KAPPA coefficient was 0.47, indicating endoscopic diagnosis. The most common endoscopic morphology of EGC and precancerous lesions was Type 0-II in 48 (76.19%) patients, of which 20 (31.75%) were Type 0-II C. Pathological diagnosis of gastric neoplastic lesions was 44 (41.75%). 69.84%. The most common endoscopic morphology was Type 0-II in 33 (75%) sites, of which 15 (34.09%) were Type 0-II C. The most common lesions were cardia and antrum, 23 (36.51%) and 22 (34.92%) respectively. There was no significant correlation between gender and age and lesion site (P 0.05). In WLI, the difference was statistically significant (P 0.05). The difference was statistically significant (P 0.001). The sensitivity and specificity of RVS typing in diagnosis of EGC were 100%, 88.1% and 85.71% respectively. "Irregular surface glandular duct" was 80.95%, 23.81%. "Increase of glandular duct density" was 71.43%, 50%. "Increase of mucosal microvessel density" was 57.14%, 66.67%. KAPPA consistency test judged the relationship between endoscopic diagnosis and postoperative pathological diagnosis. KAPPA coefficient was 0.86, suggesting that endoscopic diagnosis and postoperative pathological results were almost identical, suggesting that R. VS typing has very high diagnostic value for EGC. AUC of VS typing is 0.92, and AUC of RVS typing is 0.91. Conclusion 1. The most common endoscopic appearance of early upper gastrointestinal neoplasms and precancerous lesions is flat type (Type 0-II). Esophageal superficial flat type (Type 0-II b) is common, and gastric superficial depression type (Type 0-II) is common. ME-NBI is more advantageous than WLI and ME in the observation of pathological location, microstructure and microvascular morphology of esophagus and stomach. 3. Well classification has a good diagnostic and predictive value for early esophageal neoplasms, and its endoscopic diagnosis and postoperative pathological results have a good consistency. 4. RVS classification of five indicators contribute to gastric neoplasms. RVS typing is of high diagnostic value for EGC.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735
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