Yu Hang, Yang Ai-Ming, Lu Xing-Hua, Zhou Wei-Xun, Yao Fang, Fei Gui-Jun, Guo Tao, Yao Li-Qing, He Li-Ping, Wang Bang-Mao
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Fang Yao, Gui-Jun Fei, Tao Guo, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
World J Gastroenterol. 2015 Aug 14;21(30):9156-62. doi: 10.3748/wjg.v21.i30.9156.
To evaluate the diagnostic effectiveness of white light endoscopy, magnifying endoscopy (ME), and magnifying narrow-band imaging endoscopy (ME-NBI) in detecting early gastric cancer (EGC).
From March 2010 to June 2012, a total of 3616 patients received screening for gastric cancer by magnifying endoscopy. There were 3675 focal gastric lesions detected using conventional high definition white light endoscopy (HD-WLE) in four different referential hospitals that were recruited for further investigation using ME and ME-NBI. The images obtained from HD-WLE, ME, and ME-NBI were reviewed by four experienced endoscopists to evaluate their diagnostic effectiveness for EGC. The diagnosis of cancerous and non-cancerous lesions was conducted by evaluating the microvascular and microsurface patterns using the VS classification system. The final endoscopic diagnosis of each lesion was determined by consultation when a disagreement occurred. We used histopathological results as the gold standard for the diagnosis of EGC.
Among the 3675 lesions found, 1508 were validated by pathological findings as chronic gastritis, 1279 as chronic gastritis with intestinal metaplasia, 631 as low-grade neoplasia, and 257 as EGC. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of HD-WLE for the diagnosis of EGC were 71.2%, 99.1%, 85.5%, 97.9% and 97.1%, respectively. The results of ME for diagnosing EGC were 81.3%, 98.8%, 83.3%, 98.6% and 97.6%, respectively. The results of ME-NBI for the diagnosis of EGC were 87.2%, 98.6%, 82.1%, 99.0% and 97.8%, respectively. The diagnostic sensitivity and accuracy of paired ME and ME-NBI were significantly better than those of HD-WLE (P < 0.05).
HD-WLE has a relatively high accuracy for diagnosing EGC and is an effective screening tool. Further investigations of ME and ME-NBI are required to achieve superior accuracy.
评估白光内镜、放大内镜（ME）及放大窄带成像内镜（ME-NBI）在早期胃癌（EGC）检测中的诊断效能。
2010年3月至2012年6月，共有3616例患者接受放大内镜胃癌筛查。在四家不同的参考医院，使用传统高清白光内镜（HD-WLE）检测到3675处胃部局灶性病变，并对其采用ME和ME-NBI进行进一步检查。由四名经验丰富的内镜医师对HD-WLE、ME及ME-NBI获取的图像进行评估，以评价其对EGC的诊断效能。采用VS分类系统，通过评估微血管和微表面模式对癌性和非癌性病变进行诊断。当出现分歧时，通过会诊确定每个病变的最终内镜诊断。我们将组织病理学结果作为EGC诊断的金标准。
在发现的3675处病变中，1508处经病理检查证实为慢性胃炎，1279处为慢性萎缩性胃炎伴肠化生，631处为低级别瘤变，257处为EGC。HD-WLE诊断EGC的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为71.2%、99.1%、85.5%、97.9%和97.1%。ME诊断EGC的结果分别为81.3%、98.8%、83.3%、98.6%和97.6%。ME-NBI诊断EGC的结果分别为87.2%、98.6%、82.1%、99.0%和97.8%。配对的ME和ME-NBI的诊断灵敏度和准确度显著优于HD-WLE（P<0.05）。
HD-WLE诊断EGC具有较高的准确度，是一种有效的筛查工具。需要对ME和ME-NBI进行进一步研究以获得更高的准确度。
