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目的探讨窄带成像放大内镜(ME-NBI)联合AⅠ(醋酸+靛胭脂)三明治染色法对平坦型胃癌的诊断价值。方法对2016年1月-2017年1月南方医院深圳消化病诊疗中心及南方医科大学南方医院70例胃镜检查发现平坦型可疑胃癌病灶,分别使用白光内镜、ME-NBI、放大内镜+AⅠ三明治染色法并应用VS分类标准判断其病变性质,对可疑病灶靶向活检,以病理组织学结果为金标准,应用SPSS 16.0软件包进行统计学分析,分析其诊断的准确性。结果 70例患者中,病理组织学证实癌性病变为13处,非癌性病变57处。白光内镜下诊断胃癌的敏感度、特异度、Kappa值分别为46.2%、73.7%、0.360,ME-NBl下对应值分别84.6%、84.2%和0.819,AⅠ三明治染色+放大内镜对应值分别为86.2%、93%和0.833;应用ROC工作曲线提示AIM染色+放大内镜、ME-NBl诊断胃癌的准确性明显高于白光内镜,差异有统计学意义(P<0.01);AⅠ三明治染色法+弱放大较ME-NBl更能确定平坦型胃癌的边界,两者比较有统计学意义(P<0.01)。结论 ME-NBI与AⅠ三明治染色法结合,能鉴别平坦型病灶病变性质,特别是可提高平坦型胃癌的诊断准确性。
Objective To investigate the diagnostic value of narrow band imaging magnifying endoscopy (ME-NBI) combined with AⅠ (acetic acid + indigo rouge) sandwich staining for flat stomach cancer. Methods From January 2016 to January 2017, 70 patients with suspected gastric cancer were examined by gastroscopy in Shenzhen Southwest Hospital of Digestive Disease Treatment and Treatment Center of South Hospital and South Hospital of Southern Medical University from January 2016 to January 2017. The patients were treated with white light endoscopy, ME-NBI, magnifying endoscopy + AⅠ Sandwiches staining and VS classification criteria to determine the nature of the lesion, targeted lesions biopsy, the histopathological results as the gold standard, the application of SPSS 16.0 package for statistical analysis, analysis of the diagnostic accuracy. Results Of the 70 patients, 13 were confirmed to be pathologically cancerous and 57 were noncancerous. The sensitivity, specificity and Kappa values of white light endoscopy in diagnosing gastric cancer were 46.2%, 73.7% and 0.360 respectively, corresponding to 84.6%, 84.2% and 0.819 respectively under ME-NBl, respectively The accuracy of ME-NBl in the diagnosis of gastric cancer was significantly higher than that of white endoscopy (P <0.01). AⅠ sandwich staining Compared with ME-NBl, ME + NBl could confirm the borderline of flat stomach cancer, both of which were statistically significant (P <0.01). Conclusions ME-NBI combined with AⅠ sandwich staining can distinguish the lesions of flat lesions and improve the diagnostic accuracy of flat stomach cancer in particular.