Draşovean Silvia Cosmina, Boeriu Alina Mioara, Akabah Peter Selase, Mocan Simona Liliana, Pascarenco Ofelia Daniela, Dobru Ecaterina Daniela
Department of Gastroenterology, University of Medicine and Pharmacy of Tîrgu Mureş, Romania;
Rom J Morphol Embryol. 2018;59(2):505-512.
The pathogenesis of gastric cancer involves premalignant changes of the gastric mucosa. An accurate estimation of the topography and severity of these lesions represents an important step in detecting premalignant lesions, thereby classifying patients into low or high risk of developing gastric cancer. We prospectively analyzed the diagnostic performance of narrow-band imaging with magnification endoscopy (NBI-ME) for assessing premalignant gastric lesions during real-time examination.
PATIENTS, MATERIALS AND METHODS: A total number of 59 patients were examined by NBI-ME and target biopsies of the antrum, corporeal, and incisura angularis levels. Modified endoscopic patterns were classified into three groups: type A [tubulo-villous mucosal pattern with regular microvessels, or the light blue crest (LBC) sign], type B [disappearance of normal subepithelial capillary network (SECN) pattern], and type C [irregular mucosal pattern (IMP) and∕or irregular vascular pattern (IVP)]. The endoscopic diagnosis was compared to histological findings (the gold standard). The NBI-ME results were assessed for accuracy, sensitivity, specificity, and negative and positive predictive values in detecting intestinal metaplasia, atrophic gastritis and dysplasia.
Analysis of endoscopic patterns showed a good correlation with premalignant lesions (p<0.05). Type A pattern showed 80.2% accuracy, 80.43% sensitivity and 80% specificity [area under receiver operating characteristic (AUROC) of 0.8] in detecting intestinal metaplasia. Diagnostic performance for assessment of atrophic gastritis was not ideal (69.5% accuracy, 83.72% sensitivity, 56.04% specificity, AUROC 0.69). Pattern C represents a reliable endoscopic marker for the diagnosis of dysplasia (91.1% accuracy, 83.3% sensitivity, 91.81% specificity, AUROC 0.87). The extension of precancerous lesions was estimated during endoscopic examination.
NBI-ME represents a valuable tool in the assessment of premalignant gastric lesions, thereby categorizing patients into low and high risks of developing gastric cancer. The applicability of the method in routine practice is promising, as it helps shape the follow up protocol of patients with premalignant lesions of the stomach. It is worth mentioning that, this method requires standardization, additional training, and expertise.
胃癌的发病机制涉及胃黏膜的癌前病变。准确评估这些病变的部位和严重程度是检测癌前病变的重要步骤，从而将患者分为胃癌发生的低风险或高风险人群。我们前瞻性地分析了窄带成像放大内镜（NBI-ME）在实时检查中评估胃癌前病变的诊断性能。
患者、材料与方法：共有59例患者接受了NBI-ME检查，并对胃窦、胃体和胃角切迹水平进行了靶向活检。改良的内镜模式分为三组：A型[具有规则微血管的管状绒毛黏膜模式，或浅蓝色嵴（LBC）征]、B型[正常上皮下毛细血管网（SECN）模式消失]和C型[不规则黏膜模式（IMP）和/或不规则血管模式（IVP）]。将内镜诊断结果与组织学结果（金标准）进行比较。评估NBI-ME在检测肠化生、萎缩性胃炎和异型增生方面的准确性、敏感性、特异性以及阴性和阳性预测值。
内镜模式分析显示与癌前病变有良好的相关性（p<0.05）。A型模式在检测肠化生方面的准确率为80.2%，敏感性为80.43%，特异性为80%[受试者操作特征曲线下面积（AUROC）为0.8]。评估萎缩性胃炎的诊断性能不理想（准确率69.5%，敏感性83.72%，特异性56.单通道模式（Single Channel Mode）是指在某个系统或设备中，仅使用一个通道来传输数据、信号或进行操作的模式。在这种模式下，所有相关的信息都通过这唯一的通道进行处理和传递。例如，在一些简单的电子设备中，可能只有一个通道用于输入和输出音频信号，这就是单通道模式的一种体现。它相对简单，适用于对数据传输要求不高或系统较为基础的场景。
04%，AUROC 0.69）。C型模式是诊断异型增生的可靠内镜标志物（准确率91.1%，敏感性83.3%，特异性91.81%，AUROC 0.87）。在内镜检查过程中估计癌前病变的范围。
NBI-ME是评估胃癌前病变的有价值工具，从而将患者分为胃癌发生的低风险和高风险人群。该方法在常规实践中的适用性很有前景，因为它有助于制定胃癌前病变患者的随访方案。值得一提的是，这种方法需要标准化、额外的培训和专业知识。
