Diagnostic value of endoscopic LCPL sign for high-risk intestinal metaplasia in gastric mucosa

ZHENG Xipeng; PAN Huilin; WU Linyu; HOU Yongying; LIU Qin; MA Qiang; QIN Xiuyuan; LIU Kaijun; WANG Bin; CHEN Dongfeng; WANG Tao

doi:10.16016/j.2097-0927.202409149

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Diagnostic value of endoscopic LCPL sign for high-risk intestinal metaplasia in gastric mucosa

Monographic Reports | 更新时间：2025-03-11

- Diagnostic value of endoscopic LCPL sign for high-risk intestinal metaplasia in gastric mucosa
- Journal of Army Medical University Vol. 47, Issue 5, Pages: 407-416(2025)
- 作者机构：
  
  1.陆军特色医学中心（第三军医大学大坪医院）：，消化内科，消化系统肿瘤精准防治重庆市重点实验室，重庆
  2.陆军特色医学中心（第三军医大学大坪医院）：，病理科，重庆
  3.重庆医科大学第一临床学院，重庆
- 作者简介：
- 基金信息：
  
  the Key Project of Innovation and Development Joint Fund from Natural Science Foundation of Chongqing(CSTB2024NSCQ-LZX0015)
- DOI：10.16016/j.2097-0927.202409149
  CLC： R573;R730.49;R735.2
- Received：27 September 2024，
  
  Revised：27 December 2024，
  
  Published：15 March 2025
- 稿件说明：
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郑喜鹏，潘惠琳，吴林育，等.内镜下LCPL征象对胃黏膜高危肠上皮化生的诊断价值［J］.陆军军医大学学报，2025，47（05）：407-416.DOI：10.16016/j.2097-0927.202409149.

ZHENG X P，PAN H L，WU L Y，et al.Diagnostic value of endoscopic LCPL sign for high-risk intestinal metaplasia in gastric mucosa［J］.J Army Med Univ，2025，47（05）：407-416.DOI：10.16016/j.2097-0927.202409149.
郑喜鹏，潘惠琳，吴林育，等.内镜下LCPL征象对胃黏膜高危肠上皮化生的诊断价值［J］.陆军军医大学学报，2025，47（05）：407-416.DOI：10.16016/j.2097-0927.202409149. DOI：

ZHENG X P，PAN H L，WU L Y，et al.Diagnostic value of endoscopic LCPL sign for high-risk intestinal metaplasia in gastric mucosa［J］.J Army Med Univ，2025，47（05）：407-416.DOI：10.16016/j.2097-0927.202409149. DOI：

摘要

目的

探讨内镜下亮蓝嵴（light blue crest， LBC）包绕的乳头状区域（LBC capsuling papillary lesion， LCPL）征象在高危胃黏膜肠上皮化生（intestinal metaplasia，IM，简称“肠化”）中的诊断价值。

方法

选取2021年１月至2023年６月在陆军特色医学中心消化内科接受内镜检查及活检的314例患者（共352块活检样本）。采用HE染色及高铁二胺-阿尔新蓝（high iron diamine-alcian blue，HID-AB）染色（诊断高危肠化的金标准）检查样本的组织学类型及肠化类型，并据此将样本分为慢性炎症组、低危肠化组、高危肠化组、高-中分化肠型胃癌组、低分化肠型胃癌组。结合活检部位内镜下图像，统计分析LCPL在各组中的阳性率；采用Logistic回归分析LCPL征象与高危肠化的关系，以及与LCPL相关的临床病理特征；采用灵敏度、特异度、约登指数、受试者工作曲线下面积等指标，评价LCPL对高危肠化的诊断效能。

结果

LCPL征象在高危肠化组的阳性率达75.70%，显著高于其他各组（

均

0.001）；Logistic回归分析显示LCPL与高危肠化密切相关（

OR=

30.286，95%

CI：

13.528~67.804，

0.001）。LCPL征象诊断高危肠化的灵敏度为69.84%、特异度为93.75%、约登指数为0.636、曲线下面积为0.818（95%

：0.773~0.857）；除灵敏度指标外，上述各诊断效能参数均显著优于诊断肠化与否的传统内镜下征象LBC（

均

0.001）。并且，LCPL征象的判别不易受到患者年龄（

OR=

1.130，95%

CI：

0.709~1.800，

=0.607）、病变部位（胃角：

OR=

2.360，95%

CI：

0.73

2~7.613，

=0.151；胃窦：

OR=

2.257，95%

CI：

0.756~6.744，

=0.145）、是否合并消化性溃疡（

OR=

1.085，95%

CI：

0.208~5.652，

=0.923）等因素的影响；94.12%的阳性、66.94%的阴性LCPL征象可在3 s内被快速识别（

OR=

4.536，95%

CI：

1.372~14.997，

=0.013）。

结论

内镜下LCPL征象在诊断胃黏膜高危肠化中有较好效能，具有潜在临床应用价值。

Abstract

Objective‍　‍To investigate the diagnostic value of endoscopic sign of light blue crest (LBC) capsuling papillary lesion (LCPL) for high-risk intestinal metaplasia (IM). Methods‍　‍A total of 314 patients (352 biopsy specimens) who underwent endoscopic examination and biopsy in Department of Gastroenterology of Army Medical Center of PLA from January 2021 to June 2023 were recruited

and HE and HID-AB staining (the golden standard of high-risk IM) were apllied to detect the histological types and IM types. The samples were subsequently divided into chronic inflammation group

low-risk IM group

high-risk IM group

well-differentiated intestinal-type gastric cancer group

and poorly-differentiated intestinal-type gastric cancer group. The positive rate of LCPL in each group and its diagnostic efficacy were analyzed based on endoscopic images of the biopsy sites. Logistic regression analysis was used to investigate the relationship between LCPL sign and high-risk IM

as well as the clinical and pathological features associated with LCPL sign. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficacy of LCPL for high-risk IM

using indicators such as sensitivity

specificity

Youden index and area under the curve (AUC). Results‍　‍The positive rate of the LCPL sign in high-risk IM group was 75.70%

significantly higher than that of the other groups (all

0.001). Logistic regression analysis showed that LCPL sign was significantly correlated with high-risk IM (

OR=

30.286

95%

CI:

13.528~67.804

0.001). When the sign was employed in diagnosing high-risk IM

the sensitivity was 69.84%

the specificity was 93.75%

the Youden’s index was 0.636

and the AUC value was 0.818 (95%

: 0.773~0.857). Besides sensitivity

all above parameters of LCPL sign showed significantly better diagnostic efficacy than those of traditional LBC sign

which is used as a sign for diagnosing IM (

0.001). Moreover

recognition of LCPL sign was not easily affected by age (

OR=

1.130

95%

CI:

0.709~1.800

=0.607)

lesion site (Angular incisure:

OR=

2.360

95%

CI:

0.732~7.613

=0.151; Autrum:

OR=

2.257

95%

CI:

0.756~6.744

=0.145)

and presence of peptic ulcers (

OR=

1.085

95%

CI:

0.208~5.652

=0.923). Significantly

94.12% of positive and 66.94% of negative LCPL signs could be rapidly recognized within 3 s (

OR=

4.536

95%

CI:

1.372~14.997

=0.013). Conclusion‍　‍LCPL sign shows high efficacy and potential clinical application value for high-risk IM in gastric mucosa of endoscopic diagnosis.

关键词

Keywords

references

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