Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan.
Department of Endoscopy, Nagoya University Hospital, Nagoya 466-8560, Japan.
World J Gastroenterol. 2017 Oct 7;23(37):6894-6901. doi: 10.3748/wjg.v23.i37.6894.
To examine usefulness of virtual biopsy using endocytoscopy by comparing the endocytoscopic and histopathological images of gastric cancers.
Endocytoscopy was performed in 30 patients with early gastric cancer. Of these, 26 patients showed well differentiated adenocarcinomas, while 4 patients showed poorly differentiated adenocarcinomas (including one signet ring cell carcinoma). Cancerous and non-cancerous areas were observed after double staining with 0.05% crystal violet and 0.1% methylene blue. The endocytoscopic images obtained were evaluated by an expert endoscopist and an expert pathologist without knowledge of patient clinical data, and endocytoscopic and histopathological diagnoses were compared.
The endocytoscopic images of the cancerous area were assessed as evaluable in 25 (83.3%) and 27 (90%) patients by endoscopist A and pathologist B, respectively, and those of the non-cancerous area as evaluable in 28 (93.3%) and 23 (76.7%) patients by the endoscopist and pathologist, respectively. The sensitivity, specificity, and diagnostic accuracy of gastric cancer diagnosis using evaluable endocytoscopic images were 88.0% and 92.9%, and 90.6% by endoscopist A, and 88.9% and 91.3%, and 90.0% by pathologist B, respectively. Evaluation of the diagnostic concordance rate between the endoscopist and the pathologist by inter-observer agreement calculation revealed no significant difference between the two observers. The inter-observer agreement (-value) for endocytoscopic diagnosis was 0.745.
Endocytoscopy is useful for the differentiation of cancerous from non-cancerous gastric mucosa, making it a promising tool for virtual biopsy.
通过比较胃肿瘤的内镜下细胞学图像和组织病理学图像，来探讨内镜下细胞学活检的应用价值。
对 30 例早期胃癌患者进行内镜下细胞学检查。其中 26 例为高分化腺癌，4 例为低分化腺癌（包括 1 例印戒细胞癌）。采用 0.05%结晶紫和 0.1%亚甲基蓝双重染色法观察癌和非癌区域。由两位经验丰富的内镜医师和病理学家对内镜下细胞学图像进行评估，评估内容包括图像是否可评估以及诊断结果。评估过程中不了解患者的临床数据。然后比较内镜下细胞学诊断和组织病理学诊断的结果。
内镜医师 A 和病理学家 B 分别评估 25（83.3%）和 27（90%）例患者的癌区内镜下细胞学图像可评估，28（93.3%）和 23（76.7%）例患者的非癌区内镜下细胞学图像可评估。应用可评估的内镜下细胞学图像诊断胃癌的敏感性、特异性和准确性分别为 88.0%、92.9%和 90.6%（内镜医师 A）和 88.9%、91.3%和 90.0%（病理学家 B）。通过观察者间一致性计算评估内镜医师和病理学家的诊断一致性，发现两位观察者之间无显著差异。内镜下细胞学诊断的观察者间一致性（κ 值）为 0.745。
内镜下细胞学检查有助于区分胃肿瘤的癌性和非癌性黏膜，有望成为一种虚拟活检技术。
