电子支气管镜智能分光比色技术对中央型肺癌诊断价值初探

发布时间：2018-11-22 19:46

【摘要】：目的:选择智能分光比色技术(Fuji intelligent chromoendoscopy,FICE)在中央型肺癌应用中的最佳波长组合,探讨FICE对中央型支气管肺癌的诊断价值。方法:2016年1月至2016年10月在重庆市肿瘤医院内镜诊疗中心进行支气管镜检查,资料保存完整,有明确病理组织学诊断的患者146例纳入研究。分别用白光支气管镜(white light bronchoscopy,WLB)及FICE对病灶进行比较观察并钳取活检。分别对FICE10组波长观察下的病变组织的表面结构及黏膜浅表微血管形态显示图像清晰度进行评分,记录结果,选出最佳波长组合。观察WLB、FICE各自镜下表现,最终以病理结果作为金标准,将FICE、WLB及病理学结果进行对比研究。结果:146例患者中,最终病理结果判断恶性病例116例,良性病例30例。116例恶性病例中病理学诊断56例鳞状细胞癌,18例腺癌,35例小细胞未分化癌,3例腺鳞癌,病理类型不明确的癌4例。FICE10组波长组合对病灶观察效果具有差异性(P0.01),波长组合1(R=550(2)、G=500(4)、B=470(4),波长[nm](增益值))及8(R=540(2)、G=505(4)、B=420(5),波长[nm](增益值))分别在对观察病灶表面形态和血管纹理方面优于其他波长组合(Rank%=9.24、9.74)。FICE与病理比较对病灶性质的判断符合率为88.4%,敏感度92.2%,特异度73.3%,阳性预测值和阴性预测值分别为93.0%和71%。FICE结合白光内镜对中央型肺癌的检出率为96.6%,与单独白光支气管镜比较,检出率差异有显著性(P0.01)。分析确诊中央型肺癌的116例患者中,FICE发现17例(14.7%)侵犯范围比WLB更广(FICE结果比WLB结果㧐1cm),其中12例(10.3%)的治疗发生了改变。结论:FICE技术操作简单、图像直观,FICE波长组合1(R=550(2)、G=500(4)、B=470(4),波长[nm](增益值))及8(R=540(2)、G=505(4)、B=420(5),波长[nm](增益值))分别对观察中央型肺癌病变组织的表面结构和黏膜浅表微血管形态效果较为理想,结合WLB能提高中央型肺癌的诊断准确性,有效指导靶向病理活检,而且可以更准确地评估肺癌的局部分期,值得临床推广应用。
[Abstract]:Objective: to select the best wavelength combination of intelligent spectrophotometry (Fuji intelligent chromoendoscopy,FICE) in the application of central lung cancer and to explore the diagnostic value of FICE in central bronchogenic carcinoma. Methods: from January 2016 to October 2016, 146 patients with complete data and definite histopathological diagnosis were examined by bronchoscopy in the endoscopic diagnosis and treatment center of Chongqing Cancer Hospital. White light bronchoscopy (white light bronchoscopy,WLB) and FICE were used to compare the lesions and biopsy. The surface structure of the lesion tissue and the image clarity of the mucosal superficial microvessel displayed under the wavelength observation of the FICE10 group were scored respectively. The results were recorded and the best wavelength combination was selected. The WLB,FICE findings were observed under microscope, and the pathological results were used as gold standard. The results of FICE,WLB and pathology were compared. Results: among 146 patients, 116 cases were malignant, 30 cases were benign, 56 cases were squamous cell carcinoma, 18 cases were adenocarcinoma, 35 cases were small cell undifferentiated carcinoma, 3 cases were adenosquamous carcinoma. In the FICE10 group, there were significant differences in the effect of wavelength combination (P0.01), wavelength combination 1 (RN550 (2), GU500 (4), BX 470 (4), wavelength [nm] (gain value) and 8 (RP540 (2). GN 505 (4), BN 420 (5), Wavelength [nm] (gain value) was superior to other wavelength combinations in observing the surface morphology and vascular texture of the lesion (the coincidence rate between Rank%=9.24,9.74). FICE and pathology in judging the nature of the lesion was 88.4%). Sensitivity 92. 2, specificity 73. 3%, positive predictive value and negative predictive value 93. 0% and 71%.FICE combined with white light endoscopy the detection rate of central lung cancer was 96. 6%, compared with white light bronchoscopy alone. There was significant difference in detection rate (P0.01). Of the 116 patients diagnosed as central lung cancer, 17 (14.7%) were found to have a wider range of invasion than WLB (FICE results were better than WLB results-1cm), 12 of them (10.3%) were treated differently. Conclusion: the FICE technique is simple to operate and the image is intuitionistic. The FICE wavelength combination 1 (RN550 (2), Gn500 (4), BC470 (4), wavelength [nm] (gain value) and 8 (RP540 (2), Gn505 (4), BC420 (5) were obtained. Wavelength [nm] (gain value) was ideal for observing the surface structure of central lung cancer tissues and the morphology of mucosal superficial microvessels. Combining with WLB, the diagnostic accuracy of central lung cancer could be improved, and the target pathological biopsy could be effectively guided. Moreover, the local staging of lung cancer can be evaluated more accurately, which is worthy of clinical application.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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