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目的通过对比分析放大NBI内镜(ME-NBI)与普通白光内镜(WLE)诊断早期胃癌的准确性,评价其鉴别可疑病变的价值。方法回顾性分析行WLE或ME-NBI内镜检查发现胃部异常病灶患者218例,根据内镜类型不同将患者分为观察组110例和对照组108例。观察组行ME-NBI检查,对照组行WLE检查,2组病变均进行组织活检或内镜下切除标本病理学检查。对比2组内镜下诊断与病理诊断的情况,计算内镜诊断的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果对照组患者WLE内镜下诊断癌性病变80例,经最终“金标准”病理诊断证实其中癌变10例,非癌变70例;WLE内镜下诊断非癌性病变28例,经最终“金标准”病理诊断证实均为非癌变。观察组患者ME-NBI内镜下诊断癌性病变14例,经最终“金标准”病理诊断证实其中癌变13例,非癌变1例;ME-NBI内镜下诊断非癌性病变96例,经最终“金标准”病理诊断证实其中非癌变94例,癌变2例。对照组108例患者中,病理诊断证实非癌性病变为98例,癌性病变10例。观察组110例患者中病理诊断证实非癌性病变95例,癌性病变15例。观察组诊断EGC的特异性、阳性预测值及准确性明显高于对照组,差异均有统计学意义(P<0.05)。结论早期胃癌的筛查首选WLE,对于WLE发现的疑似病灶进一步行ME-NBI检查并在ME-NBI指引下靶向活检有助于进一步提高诊断率。
OBJECTIVE: To evaluate the diagnostic value of ME-NBI and WLE in the diagnosis of early gastric cancer by comparing the results with those of MEI-NBI and WLE. Methods A retrospective analysis of 218 patients with abnormal stomach lesions detected by WLE or ME-NBI endoscopy was divided into observation group (110 cases) and control group (108 cases) according to different endoscopic types. ME-NBI in the observation group and WLE in the control group were performed. The biopsy or endoscopic resection specimens were examined pathologically in both groups. Comparing the diagnosis of two groups of endoscopic diagnosis and pathological diagnosis of endoscopy diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Results In the control group, 80 cases of cancerous lesions were detected by WLE endoscopy, of which 10 were confirmed to be cancerous and 70 were non-cancerous by the final “gold standard” pathological examination; 28 were diagnosed non-cancerous lesions by WLE endoscopy, “Gold standard ” pathological diagnosis confirmed non-cancerous. In the observation group, 14 cases of ME-NBI endoscopically diagnosed cancerous lesions were confirmed by endoscopy, including 13 cases of canceration and 1 case of non-cancerous lesions, and 96 cases of ME-NBI non-cancerous lesions by endoscopy , The final “gold standard ” pathological diagnosis confirmed that 94 cases of non-cancerous, cancerous in 2 cases. Of the 108 patients in the control group, 98 were non-cancerous lesions and 10 were cancerous lesions. The pathological diagnosis of 110 patients in the observation group confirmed 95 non-cancerous lesions and 15 cancerous lesions. The specificity, positive predictive value and accuracy of EGC in observation group were significantly higher than those in control group (P <0.05). CONCLUSIONS: WLE is the first choice of screening for early gastric cancer. ME-NBI is further performed on suspected lesions detected by WLE and targeted biopsy under the guidance of ME-NBI is helpful to further improve the diagnosis rate.