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高分辨率显微内镜对胃黏膜肠上皮化生的诊断价值
Value of high-resolution microendoscopy in diagnosis of intestinal metaplasia in gastric mucosa
- 第三军医大学学报 2018年40卷第4期 页码：340-344
- 作者机构：
1..230032 合肥，安徽医科大学研究生院Graduate School, Anhui Medical University, Hefei, Anhui Province, 230032
2..100039 北京，武警总医院消化内科Department of Gastroenterology, General Hospital of Chinese People's Armed Police Forces, Beijing, 100039, China
- 作者简介：
- 基金信息：首都临床特色应用研究项目(Z141107002514099)
DOI：10.16016/j.1000-5404.201710160
中图分类号： R445; R573; R735.2收稿：2017-10-23，
纸质出版：2018-02-28
- 稿件说明：
移动端阅览
郑盛, 屈亚威, 刘晓不殆, 等. 高分辨率显微内镜对胃黏膜肠上皮化生的诊断价值[J]. 第三军医大学学报, 2018,40(4):340-344.
Sheng ZHENG, Yawei QU, Xiaobudai LIU, et al. Value of high-resolution microendoscopy in diagnosis of intestinal metaplasia in gastric mucosa[J]. Journal of Third Military Medical University, 2018, 40(4): 340-344.
郑盛, 屈亚威, 刘晓不殆, 等. 高分辨率显微内镜对胃黏膜肠上皮化生的诊断价值[J]. 第三军医大学学报, 2018,40(4):340-344. DOI： 10.16016/j.1000-5404.201710160.
Sheng ZHENG, Yawei QU, Xiaobudai LIU, et al. Value of high-resolution microendoscopy in diagnosis of intestinal metaplasia in gastric mucosa[J]. Journal of Third Military Medical University, 2018, 40(4): 340-344. DOI： 10.16016/j.1000-5404.201710160.
摘要
目的
2
探究高分辨率显微内镜(high resolution microendoscopy，HRME)对胃黏膜肠上皮化生(gastric intestinal metaplasia，GIM)的诊断价值。
方法
2
回顾性分析20例GIM活检标本及10例正常十二指肠黏膜活检标本的HRME图片，总结图片特点，提出GIM组织的HRME诊断标准。在此基础上，对49例患者的91处可疑胃黏膜病变先进行白光内镜诊断，靶向活检后再对标本进行HRME下的成像和预诊断。将白光内镜、HRME诊断结果与病理结果比较，评估HRME对GIM的诊断价值。
结果
2
GIM组织的HREM图像特点：小凹周围细胞排列规则，腺体呈绒毛状或宽大杵指状的基础上可见发亮的腺体边缘，绒毛结构呈周围一圈高亮、中间区域稍暗的明暗交界特征。49例患者的91处胃黏膜活检标本经病理学确诊为GIM的有57处，其中白光内镜诊断25处，HRME诊断52处，HRME对GIM的诊断明显优于白光内镜，其敏感性、特异性分别为91.23%、88.24%，与病理诊断的一致性Kappa值为0.79。
结论
2
高分辨率显微内镜对诊断GIM具有明显的敏感性、特异性以及与病理诊断的一致性，有助于GIM的早期诊断和胃癌的早期治疗。
Abstract
Objective
2
The investigate the clinical value of high-resolution microendoscopy (HRME) in the diagnosis of gastric intestinal metaplasia (GIM).
Methods
2
HRME images of 20 biopsy specimens of GIM and 10 normal duodenal mucosal biopsy specimens were analyzed to establish the diagnostic criteria for GIM. A total of 91 suspected gastric mucosal lesions in 49 patients were examined with white-light endoscopy followed by HRME examination after targeted biopsy using the established diagnostic criteria. The diagnostic value of HRME for GIM was assessed by comparing the diagnostic results of white-light endoscopy
pathological examination and HRME examination.
Results
2
The diagnostic criteria for GIM using HRME were as follows: regular alignment of the cells around the villi; presence of villiform glands
which might be broadened with bright edges; a bright-dark interface in the villous structure (bright in the peripheral and slightly dark in the middle). Of the 91 suspected lesions
57 were pathologically identified as GIM; HRME identified 52 lesions as GIM as compared with only 25 GIM lesions identified by white-light endoscopy. The sensitivity
specificity and consistent Kappa values of HRME for GIM diagnosis was 91.23%
88.24% and 0.79
respectively
showing a much better diagnostic performance of HRME than white-light endoscopy.
Conclusion
2
As a new imaging modality capable of real-time imaging of tissue pathology
HRME offers a valuable means for efficient and accurate identification of GIM to improve the diagnostic accuracy of GIM under gastroscopy.
关键词
Keywords
references
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