CAJ | 학술논문

目的评价共聚焦激光显微内镜(confoeal laser endomicroscopy,CLE)对胃部溃疡型病变的鉴别诊断价值.方法将CLE普通内镜模式下诊断为胃部溃疡型病变的患者纳入研究,转为CLE共聚焦内镜模式.对溃疡边缘和(或)表面黏膜进行扫查.随后对相同部位行黏膜活检.将CLE检查结果与病理组织学结果进行对比.结果共43例患者入选,扫查部位150个,获得图像12 769幅.与病理组织学结果比较,CLE诊断炎性病变的敏感度为83.54%、特异度为85.92%、阳性预测值为86.84%、阴性预测值为82.43%;诊断上皮内瘤变的敏感度为53.57%、特异度为88.52%、阳性预测值为51.72%、阴性预测值为89.26%;诊断胃癌的敏感度为88.37%、特异度为93.46%、阳性预测值为84.44%、阴性预测值为95.24%.在CLE与病理诊断的一致性检验中,对于炎性病变的κ值为0.69,上皮内瘤变的κ值为0.42,胃癌的κ值为0.81.结论 CLE对于胃部溃疡型病变的组织学类型可作出即刻诊断,其诊断的敏感度、特异度、阳性预测值、阴性预测值均较高,有利于指导靶向活检,提高癌前病变及胃癌的检出率.
목적 평개공취초격광현미내경(confoeal laser endomicroscopy,CLE)대위부궤양형병변적감별진단개치.방법 장CLE보통내경모식하진단위위부궤양형병변적환자납입연구,전위CLE공취초내경모식.대궤양변연화(혹)표면점막진행소사.수후대상동부위행점막활검.장CLE검사결과 여병리조직학결과 진행대비.결과 공43례환자입선,소사부위150개,획득도상12 769폭.여병리조직학결과 비교,CLE진단염성병변적민감도위83.54%、특이도위85.92%、양성예측치위86.84%、음성예측치위82.43%;진단상피내류변적민감도위53.57%、특이도위88.52%、양성예측치위51.72%、음성예측치위89.26%;진단위암적민감도위88.37%、특이도위93.46%、양성예측치위84.44%、음성예측치위95.24%.재CLE여병리진단적일치성검험중,대우염성병변적κ치위0.69,상피내류변적κ치위0.42,위암적κ치위0.81.결론 CLE대우위부궤양형병변적조직학류형가작출즉각진단,기진단적민감도、특이도、양성예측치、음성예측치균교고,유리우지도파향활검,제고암전병변급위암적검출솔.
Objective To estimate the value of confocal laser endomicroscopy (CLE)for differential diagnosis of gastric ulcer. Methods Patients diagnosed as gastric ulcer by conventional endoscopic mode of CLE were enrolled. The eonfocal endoscopic mode of CLE was used to observe the borderline and/or the surface of the ulcers. Biopsy specimen was taken for histopathological examination and the result of CLE was compared with histopathological finding. Results A total of 12 769 CLE images were obtained from 150 sites of 43 patients. The sensitivity and specificity of CLE for phlegmonosis process were 83.54% and 85.92%, respectively, with positive predictive value of 86.84% and negative predictive value of 82.43%. Whereas the sensitivity and specificity of CLE for intraepithelial neoplasia were 53.57% and 88.52%, respectively, with positive predictive value of 51.72% and negative predictive value of 89.26%. As for diagnosis of gastric cancer, the sensitivity and specificity of CLE were 88.37% and 93.46%, respectively, with positive predictive value of 84.44 % and negative predictive value of 95.24%. The kappa values for agreement of histopathological findings and CLE for diagnosis of phlegmonosis process, intraepithelial neoplasia and gastric cancer were 0.69,0.42 and 0.81, respectively. Conclusions CLE can provide a real-time histopathological diagnosis of the gastrointestinal tract with high sensitivity, specificity, positive and negative predictive values. Targeted biopsy can be done under CLE and the detective rates of precancerous lesions and tumors will be increased.