CAJ | 학술논문

目的比较共聚焦激光显微内镜(CLE)和胃黏膜活检对早期胃癌及癌前病变的诊断价值.方法 46例常规内镜诊断为可疑早期胃癌的患者首先行CLE检查,然后改常规白光内镜于病变最明显处取活检2块.将CLE诊断和胃黏膜活检诊断与内镜下切除术后或手术后最终病理结果进行对比,一致性采用Kappa检验,并计算CLE诊断癌性病变的灵敏度、特异度、阳性预测值、阴性预测值和准确率.结果最终病理诊断炎症1例、低级别上皮内瘤变4例、高级别上皮内瘤变10例、分化型腺癌28例和未分化型癌3例.CLE与最终病理诊断结果一致者38例(82.6％,38/46),两者一致性检验Kappa值为0.720;胃黏膜活检与最终病理诊断结果一致者28例(60.9％,28/46),两者一致性检验Kappa值为0.437.CLE对癌性病变诊断的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为97.6％ (40/41)、80.0％(4/5)、97.6％(40/41)、80.0％ (4/5)和95.7％ (44/46).结论 CLE对早期胃癌及其癌前病变具有较高的诊断价值,与病理组织学一致性高.
목적 비교공취초격광현미내경(CLE)화위점막활검대조기위암급암전병변적진단개치.방법 46례상규내경진단위가의조기위암적환자수선행CLE검사,연후개상규백광내경우병변최명현처취활검2괴.장CLE진단화위점막활검진단여내경하절제술후혹수술후최종병리결과진행대비,일치성채용Kappa검험,병계산CLE진단암성병변적령민도、특이도、양성예측치、음성예측치화준학솔.결과 최종병리진단염증1례、저급별상피내류변4례、고급별상피내류변10례、분화형선암28례화미분화형암3례.CLE여최종병리진단결과일치자38례(82.6％,38/46),량자일치성검험Kappa치위0.720;위점막활검여최종병리진단결과일치자28례(60.9％,28/46),량자일치성검험Kappa치위0.437.CLE대암성병변진단적민감도、특이도、양성예측치、음성예측치화준학솔분별위97.6％ (40/41)、80.0％(4/5)、97.6％(40/41)、80.0％ (4/5)화95.7％ (44/46).결론 CLE대조기위암급기암전병변구유교고적진단개치,여병리조직학일치성고.
Objective To compare the diagnositic values of confocal laser endomicroscopy (CLE) and gastric biopsy.Methods A total of 46 patients with suspicious early gastric cancer diagnosed by convential gastroscopy underwent CLE.Fluorescein sodium was intravenously injected,and suspicious lesions were observed and CLE pictures were saved.Random biopsy specimen was taken from the suspicious lesions for histopathological examination and the result of CLE and gastric biopsy was compared according to final histopathological finding.Kappa test was used to determine the consistency,and the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accurate rate were then calculated.Results Of the 46 patients with suspicious early gastric cancer,36 patients underwent endoscopic submucosal dissection (ESD) and other 10 patients underwent surgery.The Kappa value of ClE and post-ESD and surgery histopothological examination was 0.720.The Kappa value of gastric biopsy and post-ESD and surgery histopothological examination was 0.437.The sensitivity,specificity,the positive predictive value,the negative predictive value and the diagnostic accurate value of CLE in diagnosis of gastric neoplasia were 97.6％,80.0％,97.6％,80.0％ and 95.7％.Conclusion CLE is significant value for diagnosis of early gastric cancer and precancerous disease with a high consistency with histopathology.