目的 评估高分辨率显微内镜(high-resolution microendoscopy,HRME)对胃癌病理分型的诊断价值。方法 选择普外科胃癌手术切除的大体标本10例,利用HRME进行成像,总结图像特点,制定胃癌及不同病理分型胃癌的HRME诊断标准。根据建立的诊断标准,对消化内镜中心行胃镜检查发现可疑胃癌的40例活检标本进行成像并作预诊断,将预诊断结果与病理结果比较,评估HRME对胃癌分型诊断的价值。结果 HRME诊断为胃癌共32例,经病理证实为癌的共29例。经统计学分析,HRME诊断胃癌的敏感性为96.7%,特异性为70.0%,准确性为90.0%,阳性预测值为90.6%,阴性预测值分别为87.5%,一致性检验Kappa值为0.71。HRME诊断为分化型胃癌共15例,经病理证实的有12例;HRME诊断为未分化型胃癌共14例,经病理证实的有12例。经统计学分析,HRME对胃癌分型诊断的敏感性为80.0%,特异性为85.7%,准确性为82.8%,阳性预测值为85.7%,阴性预测值为80.0%。结论 根据HRME图像能够将胃癌分为分化型和未分化型,具有较高的诊断价值。
Abstract
Objective To evaluate the diagnostic value of high-resolution microendoscopy in pathological typing of gastric cancer. Methods 40 biopsy specimens suspected of gastric cancer sampled from patients undergoing gastroscopy examination in the General Hospital of Chinese People’s Armed Police Force and 10 cases of surgical resected gastric cancer specimens from the Department of General Surgery were enrolled in this study. 10 cases of surgical resection specimen of gastric cancer were used for HRME imaging to summarize the characteristics of the HRME images and make the HRME diagnostic criteria of gastric cancer and its pathological type. Based on the criteria, the endoscopic biopsy specimens suspected of gastric cancer were used for HRME imaging to make a prior diagnosis, and compared the results with pathological results to assess the diagnostic value of HRME for gastric cancer. Results 32 patients were diagnosed as cases of gastric cancer by HRME in whom 29 cases were confirmed by histopathology. By statistical analysis, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 96.7%, 70.0%, 90.0%, 90.6%, and 87.5%, respectively. In consistency analysis, k value was 0.71. Fifteen patients were diagnosed as cases of differentiated gastric cancer in whom 12 patients were confirmed by histopathology. 14 patients were diagnosed as cases of undifferentiated gastric cancer in whom 12 patients were confirmed by histopathology. On statistical analysis, the diagnostic value showed that the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 80.0%, 85.7%, 82.8%, 85.7%, and 80.0%, respectively. Conclusions According to the high-resolution microendoscopy images, gastric cancer can be divided into differentiated and undifferentiated type with high diagnostic value.
关键词
高分辨率显微内镜 /
胃癌 /
病理分型
Key words
high-resolution microendoscopy /
gastric cancer;pathological typing
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参考文献
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基金
首都临床特色应用研究(Z141107002514099)
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