卢戈氏液染色与窄带成像放大内镜在早期食管癌术前诊断中的价值比较

摘要： 目的 对比窄带成像放大内镜（NBI-ME）与卢戈氏液染色内镜（LCE）在早期食管癌（EEC）内镜切除术前诊断中的价值，评估LCE能否被NBI-ME取代。方法 收集2014年1月-2015年12月于兰州大学第二医院、兰州大学第一医院、兰州市第二医院拟行内镜下治疗的EEC病例59例，分别用NBI-ME和LCE突显病变黏膜境界、预判病理分型，结合术后的最终病理结果进行统计学分析。结果 经NBI-ME判断病变境界较清晰和非常清晰的比例为64.4%（38/59），低于LCE的91.5%（54/59），Kappa=0.208<0.4，P =0.006<0.01，两种方法一致性较差。NBI-ME预判病理分型与术后病理一致性检验提示McNemar值为5.397，P =0.369>0.05，Kappa=0.429>0.4，P =0.000<0.01，提示两者一致性尚可。LCE预判病理分型与术后病理一致性检验提示McNemar值为4.533，P =0.475>0.05，Kappa=0.286<0.4，P =0.001<0.01，提示两者一致性较差。结论 虽然NBI-ME在预判EEC病理分型方面与术后病理存在一定的一致性，且优于LCE的预判结果，但在清晰显示病变境界方面，LCE仍有明显的优势。NBI-ME尚不能取代LCE。
Abstract: Objective To compare the value of NBI with magnify endoscopy (NBI-ME) and Lugol chromoendoscopy (LCE) in preoperative assessment of early esophageal cancer, and assess whether the former can replace the latter. Methods 59 patients, sampled in the Second Hospital of Lanzhou University, the First Hospital of Lanzhou University and the Second Hospital of Lanzhou City from January 2014 to December 2015, were examined respectively by NBI-ME and Lugol chromoendoscopy not only to distinguish the lesion boundaries but also predict the pathological types as well for statistical analysis with the combination of the final postoperative pathological results. Results Only 64.4 % (38/59) of lesion boundaries can be well-distinguished by NBI-ME, which is significantly lower than that distinguished by Lugol chromoendoscopy (91.5 %, 54/59), with its kappa value 0.208 < 0.4, P < 0.01 (0.006). It indicated that poor concordance existed in these two methods. The McNemar value which reflects concordance between pathological type predicted by NBI-ME and postoperative pathology was diagnosed to be 5.397, P > 0.05 (0.369), Kappa > 0.4 (0.429), P < 0.01 (0.000), suggesting the concordance can be acceptable. However, the McNemar number diagnosed by Lugol chromoendoscopy was only 4.533, P > 0.05 (0.475), Kappa < 0.4 (0.286), P < 0.01 (0.001), showing the poor concordance instead. Conclusions To some extent, pathological type predicted by NBI-ME indeed had an concordance with postoperative pathology, which was also superior to the results examined by Lugol chromoendoscopy, while there was no denying that Lugol chromoendoscopy had an obvious advantage over NBI-ME in terms of distinguishing lesion boundaries, therefore, it can not be completely replaced with NBI-ME at present.