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  本文關鍵詞： 食管 腫瘤 放大胃鏡 窄帶成像 巴雷特食管 放大胃鏡 窄帶成像 食管 胃癌 消化系統 放大胃鏡 窄帶成像 微血管密度　出處：《蘇州大學》2015年博士論文　論文類型：學位論文

【摘要】：目的比較ME-NBI(magnifying endoscopy with narrow-band imaging,放大內鏡結合窄帶成像)靶向活檢與白光染色內鏡隨機活檢對診斷食管可疑淺表性病變的差異,探討對食管可疑淺表性病變復查胃鏡時,應用ME-NBI指導靶向活檢的價值。方法2013.01~2015.01,普通白光內鏡(white light imaging:WLI)檢查發(fā)現食管淺表性可疑腫瘤性病變65例,采用配對交叉設計分兩組。A組:先白光胃鏡+隨機活檢。4-6周后ME-NBI+靶向活檢。B組:先ME-NBI+靶向活檢,4-6周后白光胃鏡+隨機活檢。WLI觀察基礎上進行盧戈氏液染色,并取活檢。ME-NBI觀察食管病變后,以井上(Inoue)IPCL(intraepithelial papillary capillary loop上皮內乳頭狀毛細血管袢)分型為標準,指導靶向活檢。以兩種觀察模式下圖像特征及活檢結果為觀察指標,對比與病理金標準的差異。結果最終有58例患者完成整個研究,其中男38例,年齡24~82歲,平均55.6±13.3歲;女20例,27~74歲,平均54.7±11.3歲。58例患者共發(fā)現病變74處,其中68處病變作為研究對象。WLI隨機活檢診斷腫瘤性病變的Se(Sensitivity,靈敏度)為70%,Sp(specificity,特異性)為100%,PPV(positive predict value,陽性預測值)為100%,NPV(negative predict value,陰性預測值)為95.1%。ME-NBI靶向活檢診斷腫瘤性病變的Se為90%,Sp為100%,PPV為100%,NPV為98.3%。ME-NBI指導的靶向活檢診斷腫瘤性病變較WLI具有更高的Se,差異具有統計學意義(P0.05)。WLI平均活檢數量較ME-NBI更多(3.7塊/例VS 2.2塊/例,P0.05)。結論對食管淺表腫瘤性病變,ME-NBI比WLI具有更高的診斷準確性,ME-NBI指導下的靶向活檢有助于減少活檢數量。目的對比Barrett食管隨訪中,放大內鏡(magnifying endoscopy,ME)結合窄帶成像(narrow-band imaging,NBI)指導的靶向活檢與單純白光內鏡(WLI)的四象限活檢的準確性,以評價在Barrett食管的隨訪監(jiān)測中應用ME-NBI指導靶向活檢的價值。方法2012.09~2015.05,對經普通白光內鏡(WLI)及活檢病理診斷為Barrett食管的患者共96例,采用配對交叉設計,通過計算機軟件隨機決定先行WLI觀察或ME-NBI觀察,1-3月后換另一種方法觀察。分析兩種模式內鏡圖像特征及其檢查結果與病理金標準的關系,對比活檢的平均數量。結果共有88例患者完成整個研究。男56例,平均年齡52.4±12.0歲;女32例,平均年齡51.7±13.3歲。WLI檢出LGIN(Low grade intraepithelial neoplasia,低級別上皮內瘤變)16例,HGIN(High grade intraepithelial neoplasia,高級別上皮內瘤變)3例,上皮內瘤變的總檢出率:21.6%,診斷準確性為:88.6%。WLI檢出腸上皮化生(specialized intestinal metaplasia,SIM)81例,檢出率為:92.2%。ME-NBI檢出LGIN23例,HGIN 5例。上皮內瘤變的總檢出率:31.8%,診斷準確性為:98.8%。ME-NBI檢出SIM 81例,檢出率為:92.0%。ME-NBI在Barrett食管的隨訪中,檢出的上皮內瘤變較WLI為高(31.8%VS21.6%,P0.05),診斷準確性ME-NBI較WLI為高,差異存在統計學意義(88.6%vs 98.8%,P0.05)。結論在Barrett食管的隨訪檢測中,ME-NBI較WLI具有更高的上皮內瘤變檢出率,而且所需活檢數量更少。目的評估RVS(reform vessel-plus-surface classification,改良的VS分類)系統對胃早期腫瘤性病變的診斷價值。方法2012年09月至2015年05月,經WLI觀察,診斷胃內存在可疑淺表型腫瘤性病變的患者124例。其中男87例、年齡40~83歲,平均63.2±7.9歲,女37例,年齡46~77歲,平均62.6±8.2歲。30例健康體檢的志愿者作為對照。所有入組的患者進行胃鏡精查,先WLI觀察,然后行ME-NBI觀察,記錄WLI、ME-NBI下VS(vessel plus surface classification)分型、RVS分型特征,以RVS分型為標準靶向活檢。依據病變形態(tài)特征、內鏡活檢病理,行ESD(Endoscopic Submucosal Dissection內鏡粘膜下層剝離術)或手術治療。切除標本采用免疫組化方法檢測Ki67表達及MVD(microvessel density,微血管密度)計數。分析不同性質組織中Ki67的表達、MVD計數的差別,對比WLI、VS分型、RVS分型與最終病理結果的關系。結果本研究共完成118例患者的內鏡精查,觀察病變162處,其中161處病變納入統計分析。其中LGIN 84處,HGIN 63處,粘膜內癌7處,SM1(粘膜下上1/3)癌5處,SM2-3癌(粘膜下2/3)2處。胃早期腫瘤性病變中,凹陷性(IIc、III)病變占57.1%;DL(Demarcation line,邊界線)、不規(guī)則的表面腺管(Irregular microsurface pattern,IS)、不規(guī)則的粘膜微血管(Irregular microvascular pattern,IV)、腺管密度、粘膜微血管密度5項指標在非腫瘤性病變與腫瘤性病變中出現的頻率不同(P0.05)。與對照組相比,Ki67在LGIN、HGIN、EGC(early gastric cancer,早期胃癌)中的表達升高,存在統計學意義(P0.05)。HGIN、EGC中Ki67的表達較癌旁及HGIN升高具有統計學意義(P0.05)。與對照組相比,存在粘膜異型的組織(LGIN、HGIN、EGC)中,MVD均存在升高(P0.05),LGIN、癌旁組織中的MVD與EGC組相比降低具有統計學意義(P0.05)。腫瘤性病變與周圍正常組織的腺管間質距離比值(Intervening part,IP比值)為:1.57。非腫瘤性病變與周圍正常組織的腺管間質距離比值(IP比值)為:1.05。腫瘤性病變IP比值較非腫瘤性病變IP比值增大具有統計學意義(P0.01)。WLI診斷EGC的Se為89.6%、Sp為61.9%。ROC曲線下面積0.84。ME-NBI診斷EGC的Se為94.8%、Sp為83.3%,ROC曲線下面積0.93。ME-NBI診斷EGC的準確性較WLI高,差異存在統計學意義(P0.01)。VS分型診斷EGC的Se為90.9%、Sp為81.0%,ROC曲線下面積:0.89。RVS分型診斷EGC的Se為94.8%、SP為83.3%,ROC曲線下面積0.93。兩組相比RVS分型診斷EGC的Se較VS分型升高,具有統計學意義(P0.01)。結論早期胃腫瘤性病變細胞增殖活躍,Ki67表達明顯升高,MVD升高。ME-NBI下腺管密度、微血管密度可作為病變性質判斷的指標。RVS分型對胃淺表型病變具有較高的診斷準確性,值得臨床進一步推廣。與WLI相比,ME-NBI對胃淺表型腫瘤性病變具有更高的診斷準確性。
[Abstract]:Objective to compare the ME-NBI (magnifying endoscopy with narrow-band imaging, magnifying endoscopy combined with narrow band imaging) target biopsy and white light staining differences between endoscopic biopsy in the diagnosis of suspicious random esophageal superficial lesions, to explore the suspicious esophageal superficial lesions by gastroscopy, application of ME-NBI guide targeted biopsy. Methods conventional endoscopy (2013.01~2015.01 white light imaging:WLI) findings of superficial esophageal suspicious tumors in 65 cases, using the paired crossover design was divided into two groups: the first group.A white light endoscopy + random biopsy after.4-6 weeks ME-NBI+ target biopsy group.B: first ME-NBI+ targeted biopsy, after 4-6 weeks of white light endoscopy + biopsy.WLI random observation based on Lugo staining, and to observe the esophageal lesion biopsy after.ME-NBI to wells (Inoue) IPCL (intraepithelial papillary capillary loop intraepithelial papillary capillary loop) classification standard Standard guide targeted biopsy. In two observation mode image features and biopsy results as observation indexes, the difference compared with the gold standard. The results of the final pathology of 58 patients completed the trial, including 38 cases of male, aged 24~82 years old, average 55.6 + 13.3 years; 20 were female, 27~74 years old, an average of 54.7 11.3.58 patients were found in 74 lesions, including 68 lesions as the research object of.WLI random biopsy in the diagnosis of neoplastic lesions (Se Sensitivity, 70%, Sp (sensitivity) of specificity, the specificity was 100% (positive), PPV predict value, the positive predictive value was 100% (negative), NPV predict value the negative predictive value was 95.1%.ME-NBI), targeted biopsy in the diagnosis of neoplastic lesions of the Se 90%, Sp 100%, PPV 100%, NPV 98.3%.ME-NBI guided targeted biopsy in the diagnosis of neoplastic lesions than WLI has a higher Se, the difference was statistically significant (P0.05) the average number of.WLI biopsy than ME -NBI (3.7 / 2.2 / VS, P0.05). The conclusion of superficial esophageal lesions, ME-NBI has a higher diagnostic accuracy than WLI, under the guidance of ME-NBI targeted biopsy can help reduce the number of biopsy. To compare the Barrett of esophageal follow-up, magnifying endoscopy (magnifying endoscopy ME) combined with narrow band imaging (narrow-band imaging NBI) target biopsy with simple white light endoscopy guidance (WLI) the accuracy of four quadrant biopsy, to evaluate the follow-up monitoring in Barrett's esophagus in the application of ME-NBI for targeted biopsy. Methods 2012.09~2015.05 by conventional endoscopy (WLI) and biopsy for the diagnosis of Barrett's esophagus a total of 96 patients with paired crossover design, through the computer software WLI ME-NBI randomly decided to advance observation or observation, observation of another method for 1-3 months. Two models of image features and endoscopic findings and pathological The relationship between the gold standard, the average number of contrast biopsy. Results: a total of 88 patients completed the trial. 56 cases were male, mean age 52.4 + 12 years; 32 were female, mean age 51.7 + 13.3.WLI (Low grade intraepithelial neoplasia LGIN detection, low grade intraepithelial neoplasia in 16 cases, HGIN (High) grade intraepithelial neoplasia, high grade intraepithelial neoplasia) 3 cases of intraepithelial neoplasia: the total detection rate of 21.6%, the diagnostic accuracy for 88.6%.WLI detection of intestinal metaplasia (specialized intestinal, metaplasia, SIM) in 81 cases, the detection rate of 92.2%.ME-NBI LGIN23 positive cases, 5 cases of HGIN. The total intraepithelial neoplasia the detection rate of 31.8%, the diagnostic accuracy was: 98.8%.ME-NBI SIM was detected in 81 cases, the detection rate of 92.0%.ME-NBI in Barrett's esophagus during follow-up, the detection of intraepithelial neoplasia is higher than WLI (31.8%VS21.6%, P0.05), the diagnostic accuracy of ME-NBI was higher than WLI, the difference had statistical meaning Yi (88.6%vs 98.8%, P0.05). Conclusion in Barrett's esophagus were detected in ME-NBI, WLI has a higher detection rate of intraepithelial neoplasia, and required fewer biopsies. Objective: To evaluate the RVS (reform vessel-plus-surface classification, the modified VS classification system) value in the diagnosis of gastric tumors. Methods in early 2012 09 to 2015 05 months, observed by WLI, 124 cases of patients with suspected superficial tumor diagnosis in the stomach. There were 87 male, aged 40~83 years old, average 63.2 + 7.9 years, 37 cases were female, aged 46~77 years old, average 62.6 + 8.2.30 healthy volunteers as control. All in the group of patients underwent gastroscopy exploration, WLI observation, and ME-NBI observation, record WLI, ME-NBI (VS vessel plus surface classification) classification, RVS classification with RVS classification standard targeted biopsy. According to the morphological characteristics, endoscopic biopsy disease Daniel, ESD (Endoscopic Submucosal Dissection endoscopic submucosal dissection) or surgery. Specimens by immunohistochemical method to detect the expression of Ki67 and MVD (microvessel density, microvessel density count). Expression of Ki67 in different tissues, MVD count difference, compared to WLI, VS type, RVS points type and final pathological results. Results of this study were carried out in 118 patients with endoscopic observation, 162 lesions, including 161 lesions were included in the statistical analysis. The LGIN 84, HGIN 63, intramucosal carcinoma 7, SM1 (submucous 1/3) cancer 5, SM2-3 cancer (submucosal 2/3 2). Early gastric neoplastic lesions in the depression (IIc, III) lesions accounted for 57.1%; DL (Demarcation line, the boundary line), irregular surface glandular tube (Irregular microsurface, pattern, IS), irregular mucosal microvessels (Irregular microvascular pattern, IV), gland density, viscosity 5 indicators of membrane microvessel density in tumor lesions and non neoplastic lesions in different frequencies (P0.05). Compared with the control group, Ki67 in LGIN, HGIN, EGC (early gastric cancer, elevated expression in early gastric cancer), there were statistical significance (P0.05.HGIN), the expression of EGC in Ki67 is cancer and HGIN increased with statistical significance (P0.05). Compared with the control group, there is abnormal tissue mucosa (LGIN, HGIN, EGC, MVD) were increased (P0.05), LGIN, MVD in cancer tissue was significant decreased compared with EGC group (P0.05). The tumor and the surrounding normal the interstitial gland distance ratio (Intervening part, IP: 1.57. ratio) for non neoplastic lesions and normal tissue around the gland interstitial distance ratio (IP ratio): 1.05. tumor IP ratio than the non neoplastic lesions was statistically significant increase of the ratio of IP (P0.01).WLI in the diagnosis of EGC Se is 89.6%, Sp is the area under the 61.9%.ROC curve of 0.84.ME-NBI in the diagnosis of EGC Se 94.8%, Sp 83.3%, 0.93.ME-NBI area under the ROC curve of the accuracy in the diagnosis of EGC was higher than WLI, the difference was statistically significant (P0.01) diagnosis of type.VS EGC Se 90.9%, Sp 81%, ROC area under the curve type: 0.89.RVS the diagnosis of EGC Se 94.8%, SP 83.3%, ROC area under the curve of 0.93. two group compared to the diagnosis of type RVS EGC Se is VS type increased, with statistical significance (P0.01). Conclusion the proliferation of early gastric tumor cell activity, Ki67 expression was significantly increased, MVD increased density of luminal.ME-NBI, diagnostic accuracy.RVS can be used as indicators of microvessel density lesions determine the nature of the type has higher superficial gastric lesions, it is worthy of further promotion. Compared with WLI, ME-NBI has a higher diagnostic accuracy of gastric superficial neoplastic lesions.

【學位授予單位】：蘇州大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R735

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