| 摘要: |
| ［摘要］ 目的 比较细胞内镜（EC）和放大内镜联合窄带成像（ME-NBI）对早期食管癌的诊断效能。方法 招募2022年6月至2025年4月在沧州市人民医院本部内镜中心接受白光内镜（WLE）检查并发现食管黏膜可疑病变患者184例。根据内镜检查方式不同将其分为EC组（95例）和ME-NBI组（89例）。ME-NBI组有2例患者因检查前急性黏膜炎症加重主动退出研究，两组各有1例因病理活检标本质量不合格而排除，最终纳入EC组94例、ME-NBI组86例进行分析。EC组依据细胞内镜异型性（ECA）分级标准进行判读，ME-NBI组依据《中国食管癌筛查与早诊早治指南（2022，北京）》及日本内镜学会乳头内毛细血管袢分型（IPCL）标准进行判读。以病理学诊断结果为金标准，应用Kappa一致性分析探讨EC和ME-NBI检查结果与病理检查结果的一致性。比较两组诊断符合率、阳性一致率（PPA）和阴性一致率（NPA），比较两组对病变浸润深度分层、内镜形态学分型以及病变最长径判定的符合率。结果 在癌与非癌判定方面，EC检查结果和ME-NBI检查结果与病理检查结果均具有较好的一致性（Kappa=0.575，P<0.001；Kappa=0.346，P<0.001）。EC组的诊断符合率、PPA及NPA均高于ME-NBI组。在病变浸润深度分层判定方面，EC和ME-NBI检查结果与病理检查结果均具有较好的一致性（Kappa=0.871，P<0.001；Kappa=0.780，P<0.001），EC组和ME-NBI组对不同浸润深度判定的符合率无明显差异。两组对早期消化道肿瘤巴黎分型为Ⅰ型的诊断符合率比较无明显差异，EC组对Ⅱb型和Ⅱc型的诊断符合率高于ME-NBI组。EC组对病变最长径≤1 cm的判定符合率高于ME-NBI组，两组对病变最长径>1 cm的判定符合率比较无明显差异。结论 EC对早期食管癌的诊断准确性优于ME-NBI，尤其在微小病变、扁平型病变的判断中表现突出。ME-NBI在深层浸润病变评估中具有一定优势，两者联合应用有助于提高早期食管癌的诊断准确性。 |
| 关键词: 细胞内镜 放大内镜 窄带成像 早期食管癌 病理检查 一致性 |
| DOI：10.3969/j.issn.1674-3806.2026.06.12 |
| 分类号:R 735.1 |
| 基金项目:河北省医学科学研究课题计划资助项目（编号：20241639） |
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| Comparison of the diagnostic efficacy of endocytoscopy and magnifying endoscopy with narrow-band imaging for early esophageal cancer |
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ZHOU Yang1, LI Dongmei1, WANG Weiyi1, CAI Chang2
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1.Endoscopy Center, Main Campus, Cangzhou People′s Hospital, Cangzhou 061000, China; 2.Third Department of Ultrasound, Cangzhou Central Hospital, Cangzhou 061000, China
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| Abstract: |
| ［Abstract］ Objective To compare the diagnostic efficacy of endocytoscopy(EC) and magnifying endoscopy with narrow-band imaging(ME-NBI) for early esophageal cancer. Methods A total of 184 patients who underwent white-light endoscopy(WLE) in the Endoscopy Center of the Main Campus of Cangzhou People′s Hospital from June 2022 to April 2025 and were found to have suspected esophageal mucosal lesions were recruited. These patients were divided into EC group(95 patients) and ME-NBI group(89 patients) according to the different endoscopic examinations they received. Two patients in the ME-NBI group voluntarily withdrew from the study due to the aggravation of acute mucosal inflammation before the examination. One patient in each of the two groups was excluded due to the unqualified pathological biopsy specimens. Eventually, 94 patients in the EC group and 86 patients in the ME-NBI group were included for analysis. The results of the EC group were interpreted according to the Endocytoscopic Atypia(ECA) classification. The results of the ME-NBI group were interpreted according to China guideline for the screening, early detection and early treatment of esophageal cancer(2022, Beijing) and Japanese Esophageal Society′s Intrapapillary Capillary Loop Classification(IPCL) criteria. Taking the results of pathological diagnosis as the gold standard, Kappa consistency analysis was applied to explore the consistency between the results of EC and ME-NBI examinations and the results of pathological examination. The diagnostic agreement rate, positive percent agreement(PPA) and negative percent agreement(NPA) were compared between the two groups. The agreement rates of judging stratification of lesion infiltration depth, classification of endoscopic morphology and the maximum diameter of lesions were compared between the two groups. Results In terms of judging cancer and non-cancer, the results of EC examination and ME-NBI examination showed good consistency with the results of pathological examination(Kappa=0.575, P<0.001; Kappa=0.346, P<0.001). The diagnostic agreement rate, PPA and NPA in the EC group were higher than those in the ME-NBI group. In terms of judging stratification of lesion infiltration depth, the results of EC examination and ME-NBI examination showed good consistency with the results of pathological examination(Kappa=0.871, P<0.001; Kappa=0.780, P<0.001). There were no significant differences in the agreement rates of judging different infiltration depths between the EC group and the ME-NBI group. There were no differences between the two groups in the agreement rates of diagnosing early-stage digestive tract tumors with Paris Classification type Ⅰ, and the diagnostic agreement rates of type Ⅱb and type Ⅱc in the EC group were higher than those in the ME-NBI group. The judging agreement rate of the longest diameter of the lesions ≤1 cm in the EC group was higher than that in the ME-NBI group. There was no statistically significant difference in the judging agreement rate of the longest diameter of the lesions >1 cm between the two groups. Conclusion The diagnostic accuracy of the results of EC examination is better than that of ME-NBI examination for early-stage esophageal cancer, particularly in judging micro-type lesions and flat-type lesions. ME-NBI has certain advantages in assessment of deep infiltrative lesions. The combined application of EC and ME-NBI is helpful to improve the diagnostic accuracy of early-stage esophageal cancer. |
| Key words: Endocytoscopy(EC) Magnifying endoscopy Narrow-band imaging Early esophageal cancer Pathological examination Consistency |
