CAJ | 학술논문

目的：评价自体荧光（AFI）联合窄带成像（NBI）技术对早期胃癌及癌前病变的诊断价值。方法2011年2月至2012年10月新华医院门诊及住院患者140例患者常规内镜观察下有胃黏膜粗糙、糜烂、斑块、颜色异常、隆起或凹陷等改变的病灶。应用自体荧光内镜（Olympus GIF FQ260Z）进行观察，根据内镜AFI模式下荧光形态及NBI模式下黏膜微血管及胃小凹的改变，进行内镜下诊断。并于相应病变区取活检送病理检查。结果胃炎（包括浅表及萎缩性）78例，肠化45例，低级别上皮内瘤变2例，高级别瘤变4例，早期胃癌11例。自体荧光内镜联合NBI技术对肠上皮化生诊断的敏感性及特异性分别为88.89%和91.58%；对上皮内瘤变分别为83.33%和98.51%，对早期胃癌分别为90.91%和99.22%，均明显高于单纯荧光内镜。自体荧光内镜联合NBI技术诊断早期胃癌的阳性预测值为90.91%，阴性预测值为99.22%。AFI联合NBI的内镜诊断与病理诊断的一致性kappa系数为0.928，两者的一致性好。结论自体荧光联合NBI技术可提高早期胃癌和癌前病变的检出率。
목적：평개자체형광（AFI）연합착대성상（NBI）기술대조기위암급암전병변적진단개치。방법2011년2월지2012년10월신화의원문진급주원환자140례환자상규내경관찰하유위점막조조、미란、반괴、안색이상、륭기혹요함등개변적병조。응용자체형광내경（Olympus GIF FQ260Z）진행관찰，근거내경AFI모식하형광형태급NBI모식하점막미혈관급위소요적개변，진행내경하진단。병우상응병변구취활검송병리검사。결과위염（포괄천표급위축성）78례，장화45례，저급별상피내류변2례，고급별류변4례，조기위암11례。자체형광내경연합NBI기술대장상피화생진단적민감성급특이성분별위88.89%화91.58%；대상피내류변분별위83.33%화98.51%，대조기위암분별위90.91%화99.22%，균명현고우단순형광내경。자체형광내경연합NBI기술진단조기위암적양성예측치위90.91%，음성예측치위99.22%。AFI연합NBI적내경진단여병리진단적일치성kappa계수위0.928，량자적일치성호。결론자체형광연합NBI기술가제고조기위암화암전병변적검출솔。
Objectives To explore the diagnosis value of auto fluorescence imaging endoscopy combined with narrow band imaging(NBI) technology in the identification of early gastric cancer and precancerous lesions. Methods One hundred and forty outpatients and patients with gastric mucosa roughness, erosion, plaque, abnormal color or indentation in conventional endoscopy were enrolled from February 2011 to October 2012 in Xinhua hospital. Using Olympus GIF FQ260Z,endoscopic diagnosis were made according to the auto fluorescence imaging, the change of both pit pattern and epithelium capillary by NBI. The biopsies underwent pathologic evaluation. Results Seventy eight cases were histologically diagnosed as gastritis(including superficial and atrophy), 45 as intestine metaplasia(IM), 2 as low-grade intraepithelial neoplasia, 4 as high-grade intraepithelial neoplasia and 11 as early gastric cancer. The sensitivity and specificity of trimodal imaging endoscopy in the diagnosis of IM, intraepithelial neoplasia and early gastric cancer were 88.89%, 91.58%;83.33%, 98.51%;90.91%, 99.22%respectively. All were higher than those of routine endoscopy. The early gastric cancer could be diagnosed by trimodal imaging endoscopy with the positive predictive value of 90.91%and negative value of 99.22%. The concordance between endoscopic diagnosis by AFI combined NBI and histological diagnosis was evaluated. The Kappa coefficient was 0.928, which demonstrated good consistency. Conclusion AFI combined with NBI endoscopy can enhance the detection rate of early gastric cancer and precancerous lesions.