電子支氣管鏡智能分光比色技術(shù)對(duì)中央型肺癌診斷價(jià)值初探
發(fā)布時(shí)間：2018-11-22 19:46
【摘要】：目的:選擇智能分光比色技術(shù)(Fuji intelligent chromoendoscopy,FICE)在中央型肺癌應(yīng)用中的最佳波長(zhǎng)組合,探討FICE對(duì)中央型支氣管肺癌的診斷價(jià)值。方法:2016年1月至2016年10月在重慶市腫瘤醫(yī)院內(nèi)鏡診療中心進(jìn)行支氣管鏡檢查,資料保存完整,有明確病理組織學(xué)診斷的患者146例納入研究。分別用白光支氣管鏡(white light bronchoscopy,WLB)及FICE對(duì)病灶進(jìn)行比較觀察并鉗取活檢。分別對(duì)FICE10組波長(zhǎng)觀察下的病變組織的表面結(jié)構(gòu)及黏膜淺表微血管形態(tài)顯示圖像清晰度進(jìn)行評(píng)分,記錄結(jié)果,選出最佳波長(zhǎng)組合。觀察WLB、FICE各自鏡下表現(xiàn),最終以病理結(jié)果作為金標(biāo)準(zhǔn),將FICE、WLB及病理學(xué)結(jié)果進(jìn)行對(duì)比研究。結(jié)果:146例患者中,最終病理結(jié)果判斷惡性病例116例,良性病例30例。116例惡性病例中病理學(xué)診斷56例鱗狀細(xì)胞癌,18例腺癌,35例小細(xì)胞未分化癌,3例腺鱗癌,病理類型不明確的癌4例。FICE10組波長(zhǎng)組合對(duì)病灶觀察效果具有差異性(P0.01),波長(zhǎng)組合1(R=550(2)、G=500(4)、B=470(4),波長(zhǎng)[nm](增益值))及8(R=540(2)、G=505(4)、B=420(5),波長(zhǎng)[nm](增益值))分別在對(duì)觀察病灶表面形態(tài)和血管紋理方面優(yōu)于其他波長(zhǎng)組合(Rank%=9.24、9.74)。FICE與病理比較對(duì)病灶性質(zhì)的判斷符合率為88.4%,敏感度92.2%,特異度73.3%,陽(yáng)性預(yù)測(cè)值和陰性預(yù)測(cè)值分別為93.0%和71%。FICE結(jié)合白光內(nèi)鏡對(duì)中央型肺癌的檢出率為96.6%,與單獨(dú)白光支氣管鏡比較,檢出率差異有顯著性(P0.01)。分析確診中央型肺癌的116例患者中,FICE發(fā)現(xiàn)17例(14.7%)侵犯范圍比WLB更廣(FICE結(jié)果比WLB結(jié)果㧐1cm),其中12例(10.3%)的治療發(fā)生了改變。結(jié)論:FICE技術(shù)操作簡(jiǎn)單、圖像直觀,FICE波長(zhǎng)組合1(R=550(2)、G=500(4)、B=470(4),波長(zhǎng)[nm](增益值))及8(R=540(2)、G=505(4)、B=420(5),波長(zhǎng)[nm](增益值))分別對(duì)觀察中央型肺癌病變組織的表面結(jié)構(gòu)和黏膜淺表微血管形態(tài)效果較為理想,結(jié)合WLB能提高中央型肺癌的診斷準(zhǔn)確性,有效指導(dǎo)靶向病理活檢,而且可以更準(zhǔn)確地評(píng)估肺癌的局部分期,值得臨床推廣應(yīng)用。
[Abstract]:Objective: to select the best wavelength combination of intelligent spectrophotometry (Fuji intelligent chromoendoscopy,FICE) in the application of central lung cancer and to explore the diagnostic value of FICE in central bronchogenic carcinoma. Methods: from January 2016 to October 2016, 146 patients with complete data and definite histopathological diagnosis were examined by bronchoscopy in the endoscopic diagnosis and treatment center of Chongqing Cancer Hospital. White light bronchoscopy (white light bronchoscopy,WLB) and FICE were used to compare the lesions and biopsy. The surface structure of the lesion tissue and the image clarity of the mucosal superficial microvessel displayed under the wavelength observation of the FICE10 group were scored respectively. The results were recorded and the best wavelength combination was selected. The WLB,FICE findings were observed under microscope, and the pathological results were used as gold standard. The results of FICE,WLB and pathology were compared. Results: among 146 patients, 116 cases were malignant, 30 cases were benign, 56 cases were squamous cell carcinoma, 18 cases were adenocarcinoma, 35 cases were small cell undifferentiated carcinoma, 3 cases were adenosquamous carcinoma. In the FICE10 group, there were significant differences in the effect of wavelength combination (P0.01), wavelength combination 1 (RN550 (2), GU500 (4), BX 470 (4), wavelength [nm] (gain value) and 8 (RP540 (2). GN 505 (4), BN 420 (5), Wavelength [nm] (gain value) was superior to other wavelength combinations in observing the surface morphology and vascular texture of the lesion (the coincidence rate between Rank%=9.24,9.74). FICE and pathology in judging the nature of the lesion was 88.4%). Sensitivity 92. 2, specificity 73. 3%, positive predictive value and negative predictive value 93. 0% and 71%.FICE combined with white light endoscopy the detection rate of central lung cancer was 96. 6%, compared with white light bronchoscopy alone. There was significant difference in detection rate (P0.01). Of the 116 patients diagnosed as central lung cancer, 17 (14.7%) were found to have a wider range of invasion than WLB (FICE results were better than WLB results-1cm), 12 of them (10.3%) were treated differently. Conclusion: the FICE technique is simple to operate and the image is intuitionistic. The FICE wavelength combination 1 (RN550 (2), Gn500 (4), BC470 (4), wavelength [nm] (gain value) and 8 (RP540 (2), Gn505 (4), BC420 (5) were obtained. Wavelength [nm] (gain value) was ideal for observing the surface structure of central lung cancer tissues and the morphology of mucosal superficial microvessels. Combining with WLB, the diagnostic accuracy of central lung cancer could be improved, and the target pathological biopsy could be effectively guided. Moreover, the local staging of lung cancer can be evaluated more accurately, which is worthy of clinical application.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2
本文編號(hào)：2350360
[Abstract]:Objective: to select the best wavelength combination of intelligent spectrophotometry (Fuji intelligent chromoendoscopy,FICE) in the application of central lung cancer and to explore the diagnostic value of FICE in central bronchogenic carcinoma. Methods: from January 2016 to October 2016, 146 patients with complete data and definite histopathological diagnosis were examined by bronchoscopy in the endoscopic diagnosis and treatment center of Chongqing Cancer Hospital. White light bronchoscopy (white light bronchoscopy,WLB) and FICE were used to compare the lesions and biopsy. The surface structure of the lesion tissue and the image clarity of the mucosal superficial microvessel displayed under the wavelength observation of the FICE10 group were scored respectively. The results were recorded and the best wavelength combination was selected. The WLB,FICE findings were observed under microscope, and the pathological results were used as gold standard. The results of FICE,WLB and pathology were compared. Results: among 146 patients, 116 cases were malignant, 30 cases were benign, 56 cases were squamous cell carcinoma, 18 cases were adenocarcinoma, 35 cases were small cell undifferentiated carcinoma, 3 cases were adenosquamous carcinoma. In the FICE10 group, there were significant differences in the effect of wavelength combination (P0.01), wavelength combination 1 (RN550 (2), GU500 (4), BX 470 (4), wavelength [nm] (gain value) and 8 (RP540 (2). GN 505 (4), BN 420 (5), Wavelength [nm] (gain value) was superior to other wavelength combinations in observing the surface morphology and vascular texture of the lesion (the coincidence rate between Rank%=9.24,9.74). FICE and pathology in judging the nature of the lesion was 88.4%). Sensitivity 92. 2, specificity 73. 3%, positive predictive value and negative predictive value 93. 0% and 71%.FICE combined with white light endoscopy the detection rate of central lung cancer was 96. 6%, compared with white light bronchoscopy alone. There was significant difference in detection rate (P0.01). Of the 116 patients diagnosed as central lung cancer, 17 (14.7%) were found to have a wider range of invasion than WLB (FICE results were better than WLB results-1cm), 12 of them (10.3%) were treated differently. Conclusion: the FICE technique is simple to operate and the image is intuitionistic. The FICE wavelength combination 1 (RN550 (2), Gn500 (4), BC470 (4), wavelength [nm] (gain value) and 8 (RP540 (2), Gn505 (4), BC420 (5) were obtained. Wavelength [nm] (gain value) was ideal for observing the surface structure of central lung cancer tissues and the morphology of mucosal superficial microvessels. Combining with WLB, the diagnostic accuracy of central lung cancer could be improved, and the target pathological biopsy could be effectively guided. Moreover, the local staging of lung cancer can be evaluated more accurately, which is worthy of clinical application.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2
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