窄带成像喉镜联合咽喉反流量表对喉癌诊断效能的对比研究

刘健; 姜振东; 兰发璋; 何亚; 唐正; 钟诚

doi:10.16016/j.2097-0927.202206192

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窄带成像喉镜联合咽喉反流量表对喉癌诊断效能的对比研究

临床医学 | 更新时间：2026-01-09

- 窄带成像喉镜联合咽喉反流量表对喉癌诊断效能的对比研究
- Diagnostic value of narrow-band imaging laryngoscopy combined with laryngopharyngeal reflux scale for laryngeal carcinoma and precancerous lesions
- 陆军军医大学学报 2023年45卷第2期页码：180-185
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院耳鼻咽喉头颈外科
- 作者简介：
  
  [ 钟诚，Email：agm95zc@163.com ZHONG Cheng, E-mail: agm95zc@163.com
- 基金信息：
- DOI：10.16016/j.2097-0927.202206192
  中图分类号： R730.4;R739.65;R767.04
- 收稿：2022-06-29，
  
  修回：2022-08-02，
  
  纸质出版：2023-01-30
- 稿件说明：
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刘健, 姜振东, 兰发璋, 等. 窄带成像喉镜联合咽喉反流量表对喉癌诊断效能的对比研究[J]. 陆军军医大学学报, 2023,45(2):180-185.

Jian LIU, Zhendong JIANG, Fazhang LAN, et al. Diagnostic value of narrow-band imaging laryngoscopy combined with laryngopharyngeal reflux scale for laryngeal carcinoma and precancerous lesions[J]. Journal of Army Medical University, 2023, 45(2): 180-185.
刘健, 姜振东, 兰发璋, 等. 窄带成像喉镜联合咽喉反流量表对喉癌诊断效能的对比研究[J]. 陆军军医大学学报, 2023,45(2):180-185. DOI： 10.16016/j.2097-0927.202206192.

Jian LIU, Zhendong JIANG, Fazhang LAN, et al. Diagnostic value of narrow-band imaging laryngoscopy combined with laryngopharyngeal reflux scale for laryngeal carcinoma and precancerous lesions[J]. Journal of Army Medical University, 2023, 45(2): 180-185. DOI： 10.16016/j.2097-0927.202206192.

摘要

目的

探讨窄带成像(narrow-band imaging，NBI)喉镜联合咽喉反流量表对喉癌的诊断效能。

方法

本研究设计方案为横断面研究。选取2021年12月至2022年4月在陆军军医大学第一附属医院耳鼻咽喉科就诊并于白光喉镜下疑似喉癌或癌前病变的患者共96例，其中男87例，女9例，使用窄带成像喉镜的白光模式和NBI模式进行检查及反流体征量表(reflux finding score，RFS)评分，并在同一名专业医师指导下进行反流症状指数(reflux symptom index，RSI)量表评分。分别应用白光模式、NBI模式及两种模式联合咽喉反流量表评估病灶的良恶性。以病理结果作为金标准，统计对比白光、NBI、白光+咽喉反流量表、NBI+咽喉反流量表之间的准确率、敏感度和特异度之间的差异，对4种方法的诊断效能进行ROC配对分析并绘制ROC曲线。

结果

入组96例患者良性病变20例，癌前病变33例，恶性病变43例。准确率、敏感度和特异度：白光模式为71.88%、60.47%和81.13%；NBI模式为92.71%、90.70%和94.34%；白光+咽喉反流量表为83.33%、81.40%和84.91%；NBI+咽喉反流量表为92.71%、95.35%和90.57%。良性病变、癌前病变、喉癌的RFS评分均值在白光模式下分别为4

.20±0.68、5.85±2.32、9.49±2.56；NBI模式下分别为4.50±0.92、6.70±2.67、10.77±2.18；RSI评分均值分别为9.10±1.77、10.88±2.22、12.40±2.86。NBI分型Ⅰ~Ⅴc型RFS评分均值分别为4.31±0.61、4.67±1.25、6.23±3.07、7.27±2.26、10.16±2.68、11.06±2.07、11.33±1.70；RSI均值分别为9.08±1.59、9.50±1.89、10.15±2.32、11.73±2.72、12.21±2.67、12.53±3.17、15.33±3.70。NBI模式的准确性、敏感度和特异性均高于白光模式(

0.05)；白光+咽喉反流量表的准确性及敏感度高于白光模式(

0.05)，特异性无统计学差异；NBI+咽喉反流量表的准确性、敏感度和特异性对比NBI模式均无统计学差异。白光与NBI、白光与白光+咽喉反流量表的AUC差值分别为-0.094 (95%

：-0.167~-0.020)、-0.111 (95%

：-0.178~-0.044)，差异均有统计学意义(

0.05)。其余方法之间AUC对比未发现统计学差异。

结论

NBI模式与白光+咽喉反流量表对喉癌及癌前病变的诊断能力均高于白光模式。

Abstract

Objective

To evaluate the value of narrow-band imaging (NBI) laryngoscopy combined with laryngopharyngeal reflux scale in the diagnosis of laryngeal malignant tumors and precancerous lesions.

Methods

A cross-sectional study was conducted on 96 patients (87 males and 9 females) with suspected laryngeal cancer or precancerous lesions under white light laryngoscope from December 2021 to April 2022. All patients were examined and compared with under white light mode and NBI mode of laryngoscopy as well as scored with reflux sign scale (reflux finding score

RFS). The reflux symptom index (RSI) scale was scored under the guidance of the same professional physician. White light mode

NBI mode

white light mode combined with throat reflux scale and NBI mode combined with throat reflux scale were used to evaluate the benign and malignant lesions. The pathological results of biopsy or operation were confirmed and regarded as diagnostic criteria. The accuracy

sensitivity and specificity in white light mode

NBI mode

white light mode combined RSI

and NBI mode combined RSI were compared

and the diagnostic effectiveness of the 4 Methods were analyzed and compared using receiver operating characteristic (ROC) pairing analysis and ROC curve analysis.

Results

Among the 96 patients

20 cases were benign lesions

33 cases were precancerous lesions and 43 cases were malignant lesions. The accuracy

sensitivity

and specificity was 71.88%

60.47% and 81.13%

respectively

for the white light mode; was 92.71%

90.70% and 94.34%

respectively in the NBI mode

was 83.33%

81.40% and 84.91%

respectively

for white light mode combined with RSI; and was 92.71%

95.35% and 90.57%

respectively for NBI mode combined with RSI. The average score of RFS corresponding to the 3 pathological grades (benign

precancerous and malignant lesions) were 4.20±0.68

5.85±2.32 and 9.49±2.56 in white light mode

4.50±0.92

6.70±2.67 and 10.77±2.18 in NBI mode

and the score of RSI was 9.10±1.77

10.88±2.22 and 12.40±2.86

respectively. The average score of RFS of NBI classification I-Vc were 4.31±0.61

4.67±1.25

6.23±3.07

7.27±2.26

10.16±2.68

11.06±2.07 and 11.33±1.70

respectively. The average score of RSI was 9.08±1.59

9.50±1.89

10.15±2.32

11.73±2.72

12.21±2.67

12.53±3.17 and 15.33±3.70

respectively. The accuracy

sensitivity and specificity of NBI mode were significantly higher than those of white light mode (

0.05); And so were white light model combined with laryngopharyngeal reflux scale than white light model (

0.05)

but there was no statistical difference in specificity; There were no statistical differences in accuracy

sensitivity and specificity between NBI model and laryngopharyngeal reflux scale. The AUC difference between white light model and NBI

white light model and white light model combined with laryngeal reflux scale were -0.094 (95%

: -0.167~-0.020) and -0.111 (95%

: -0.178~-0.044)

respectively (

0.05)

which were statistically significant.

Conclusion

The diagnostic value of NBI model and white light model combined with laryngeal reflux scale is higher than that of white light model in laryngeal carcinoma and precancerous lesions.

关键词

Keywords

references

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