Yang Jing, Huang Jin, Yang Yunsheng, Fan Nannan, Zhang Xiuli, Wang Shufang, Li Jie, Meng Jiangyun
Department of Gastroenterology and Hepatology, Chinese PLA General Hospital Beijing 100853, China.
Int J Clin Exp Med. 2015 Jun 15;8(6):8905-15. eCollection 2015.
Confocal laser endoscopy (CLE) diagnostic criteria for lymph node metastasis of gastric cancer was established and evaluated to provide a basis for CLE clinical application in the diagnosis of abdominal lymph node metastasis. CLE scanning (surface scanning and sectional scanning) and pathology examination were conducted in gastric cancer tissues and lymph nodes of 5 cases. Characteristics of lymphatic metastasis in CLE imaging were observed and summarized in combination with pathology. The diagnostic criteria were corroborated in 124 lymph nodes of another 14 cases and CLE detection time needed for diagnosis was recorded. The CLE diagnostic criteria were tested and evaluated, and the effect of lymph node size on the diagnosis accuracy was determined. All the 19 participants were confirmed as gastric cancer. Sectional scanning can get comprehensive observation for internal structures of lymph nodes, in which abnormal large heterocyst appeared with special structural changes. CLE scanning could detect 88.75% of the positive metastasis and 68.18% of the negative metastasis examined by the pathology methods based on the established CLE diagnostic criteria. In comparison with pathological diagnosis, specificity, sensitivity and accuracy of CLE diagnosis were 88.75%, 68.18% and 81.45%, respectively. Accuracies of CLE diagnosis on the lymph nodes grouped by size were 85.29%, 77.78% and 88.89%, respectively, with no significant difference between groups (P > 0.05). Complete internal structures of lymph nodes can be observed clearly by CLE sectional scanning. The size of lymph nodes had no effects on diagnosis accuracy. CLE shows better sensitivity and specificity than traditional pathological diagnosis.
建立并评估了共聚焦激光内镜（CLE）诊断胃癌淋巴结转移的标准，为CLE在腹部淋巴结转移诊断中的临床应用提供依据。对5例胃癌组织及淋巴结进行了CLE扫描（表面扫描和断层扫描）及病理检查。结合病理观察并总结CLE成像中淋巴结转移的特征。在另外14例的124个淋巴结中验证诊断标准，并记录诊断所需的CLE检测时间。对CLE诊断标准进行测试和评估，确定淋巴结大小对诊断准确性的影响。所有19名参与者均确诊为胃癌。断层扫描可全面观察淋巴结内部结构，其中出现异常大的异型囊肿并伴有特殊结构变化。基于建立的CLE诊断标准，CLE扫描能检测出病理方法检查的阳性转移淋巴结的88.75%和阴性转移淋巴结的68.18%。与病理诊断相比，CLE诊断的特异性、敏感性和准确性分别为88.75%、68.18%和81.45%。按大小分组的淋巴结CLE诊断准确性分别为85.29%、77.78%和88.89%，组间差异无统计学意义（P>0.05）。通过CLE断层扫描可清晰观察到淋巴结完整的内部结构。淋巴结大小对诊断准确性无影响。与传统病理诊断相比，CLE显示出更好的敏感性和特异性。
