Please wait a minute...
浙江大学学报（医学版）
浙江大学学报（医学版）  2019, Vol. 48 Issue (5): 504-510    DOI: 10.3785/j.issn.1008-9292.2019.10.07
原著     
探头式激光共聚焦显微内镜在胃癌及癌前病变临床诊断中的作用
马盼盼1(),蔡利军1,吕宾1,*(),乐敏2,*()
1. 浙江中医药大学附属第一医院消化内科 浙江省消化道疾病病理生理研究重点实验室, 浙江 杭州 310006
2. 浙江大学医学院附属第一医院消化内科, 浙江 杭州 310003
Application of probe-based confocal laser endomicroscopy in diagnosis of gastric carcinoma and precancerous lesions
MA Panpan1(),CAI Lijun1,LYU Bin1,*(),YUE Min2,*()
1. Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Key Laboratory for Pathophysiological Research on Digestive System Diseases, Hangzhou 310006, China
2. Department of Gastroenterology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
 全文: PDF(8775 KB)   HTML( 6 )
摘要：

目的: 探讨探头式共聚焦激光显微内镜（pCLE）在胃癌及其癌前病变临床诊断中的作用。方法: 选取2013年12月至2014年11月于浙江大学医学院附属第一医院及2014年1月至2017年12月于浙江中医药大学附属第一医院行pCLE上消化道检查患者的资料，根据已知胃黏膜病变的pCLE诊断标准，以病理诊断作为金标准，统计分析pCLE诊断萎缩性胃炎（AG）、胃黏膜肠上皮化生（GIM）、低级别上皮内瘤变（LGIN）、高级别上皮内瘤变（HGIN，包含胃癌）的诊断效能。结果: 共纳入119例患者，共计154个胃黏膜病变。pCLE诊断AG的敏感度、特异度分别为94.34%、91.09%，符合率为92.21%，κ值为0.83。pCLE诊断GIM的敏感度、特异度分别为84.47%、92.16%，符合率为87.01%，κ值为0.72。pCLE与病理诊断完全型GIM的符合率为0.75，κ值为0.49；诊断不完全型GIM的符合率为0.79，κ值为0.48。pCLE诊断LGIN的敏感度、特异度分别为85.29%、87.50%，符合率为87.01%，κ值为0.66；pCLE诊断HGIN的敏感度、特异度分别为95.83%、97.17%，符合率为96.75%，κ值为0.92。结论: pCLE可用于诊断胃癌及癌前病变且诊断效能高，并可对GIM进行初步分型诊断。
关键词： 癌前状态/病理学;  胃肿瘤/病理学;  内窥镜检查;  激光    
Abstract:

Objective: To assess the application of probe-based confocal laser endomicroscopy (pCLE) in diagnosis of gastric carcinoma and precancerous lesions. Methods: Patients underwent pCLE in the First Affiliated Hospital of Zhejiang University School of Medicine during December 2013 and November 2014 and in the First Affiliated Hospital of Zhejiang Chinese Medical University during January 2014 and December 2017 were enrolled. The consistency between pCLE diagnosis and pathological diagnosis of gastric lesions, including atrophic gastritis, gastric intestinal metaplasia, low-grade intraepithelial neoplasia and high-grade intraepithelial neoplasia (including gastric carcinoma) was analyzed. Results: Totally 154 gastric lesions from 119 patients were detected by pCLE. Using pathological diagnosis as gold standard, the sensitivity, specificity, coincidence rate and κ value of pCLE diagnosis for atrophic gastritis were 94.34%, 91.09%, 92.21%and 0.83; those indicators for gastric intestinal metaplasia were 84.47%, 92.16%, 87.01% and 0.72. The coincidence rate and κ value of pCLE diagnosis of complete gastric intestinal metaplasia were 0.75 and 0.49; for incomplete gastric intestinal metaplasia were 0.79 and 0.48, respectively. The sensitivity, specificity, coincidence rate and κ value of pCLE diagnosis for low-grade intraepithelial neoplasia were 85.29%, 87.50%, 87.01%and 0.66; those for high-grade intraepithelial neoplasia (including gastric carcinoma) were 95.83%, 97.17%, 96.75%and 0.92. Conclusion: pCLE can be used for diagnosis of gastric carcinoma and pericancerous lesions and also for typing of gastric intestinal metaplasia.
Key words: Precancerous conditions/pathology    Stomach neoplasms/pathology    Endoscopy    Lasers
收稿日期: 2019-04-09 出版日期: 2020-01-04
:  R730.49  
基金资助: 国家自然科学基金(81770535);浙江省自然科学基金(LY16H290001);国家中医药管理局重大疑难疾病中西医临床协作试点项目;浙江省医药卫生科技计划(2016KYB094)
通讯作者: 吕宾,乐敏     E-mail: mapanpan0616@163.com;lvbin@medmail.com.cn;1376186619@qq.com
作者简介: 马盼盼(1990—), 女, 博士, 住院医师, 主要从事消化道早期癌症和炎性肠疾病相关研究; E-mail: mapanpan0616@163.com; https://orcid.org/0000-0003-1193-9454
服务　　
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章　　
马盼盼
蔡利军
吕宾
乐敏

引用本文:

马盼盼,蔡利军,吕宾,乐敏. 探头式激光共聚焦显微内镜在胃癌及癌前病变临床诊断中的作用[J]. 浙江大学学报（医学版）, 2019, 48(5): 504-510.

MA Panpan,CAI Lijun,LYU Bin,YUE Min. Application of probe-based confocal laser endomicroscopy in diagnosis of gastric carcinoma and precancerous lesions. J Zhejiang Univ (Med Sci), 2019, 48(5): 504-510.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2019.10.07    或    http://www.zjujournals.com/med/CN/Y2019/V48/I5/504

图 1  胃癌及癌前病变的pCLE及组织病理学表现
pCLE诊断AG病理诊断GIM病理诊断LGIN病理诊断HGIN病理诊断
阳性阴性总计阳性阴性总计阳性阴性总计阳性阴性总计
pCLE：探头式共聚焦激光显微内镜；AG：萎缩性胃炎；GIM：胃黏膜肠上皮化生；LGIN：低级别上皮内瘤变；HGIN：高级别上皮内瘤变.
阳性509598749129154446349
阴性3929516476351051102103105
总计53101154103511543412015448106154
表 1  胃癌及癌前病变的pCLE诊断与病理诊断结果比较
癌前病变敏感度(%)特异度(%)阳性预测值(%)阴性预测值(%)约登指数
AG：萎缩性胃炎；GIM：胃黏膜肠上皮化生；LGIN：低级别上皮内瘤变；HGIN：高级别上皮内瘤变.
AG94.34(83.37~98.53)91.09(83.32~95.59)84.75(72.51~92.37)96.84(90.39~99.18)0.8543(0.6669~0.9412)
GIM84.47(75.70~90.59)92.16(80.25~97.46)95.60(88.50~98.58)74.60(61.81~84.37)0.7663(0.5595~0.8805)
LGIN85.29(68.17~94.46)87.50(79.92~92.60)65.91(50.00~79.07)95.45(89.20~98.31)0.7279(0.4809~0.8706)
HGIN95.83(84.57~99.28)97.17(91.35~99.27)93.88(82.13~98.41)98.10(92.62~99.67)0.9300(0.7592~0.9855)
表 2  探头式共聚焦激光显微内镜诊断胃癌及癌前病变的效能
1 TORRE L A , BRAY F , SIEGEL R L et al. Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015, 65 (2): 87- 108
doi: 10.3322/caac.21262
2 CHEN W , SUN K , ZHENG R et al. Cancer incidence and mortality in China, 2014[J]. Chin J Cancer Res, 2018, 30 (1): 1- 12
doi: 10.21147/j.issn.1000-9604.2018.01.01
3 WALLACE M B , FOCKENS P . Probe-based confocal laser endomicroscopy[J]. Gastroenterology, 2009, 136 (5): 1509- 1513
doi: 10.1053/j.gastro.2009.03.034
4 LIU T , ZHENG H , GONG W et al. The accuracy of confocal laser endomicroscopy, narrow band imaging, and chromoendoscopy for the detection of atrophic gastritis[J]. J Clin Gastroenterol, 2015, 49 (5): 379- 386
doi: 10.1097/MCG.0000000000000164
5 GUO Y T , LI Y Q , YU T et al. Diagnosis of gastric intestinal metaplasia with confocal laser endomicroscopy in vivo: a prospective study[J]. Endoscopy, 2008, 40 (7): 547- 553
doi: 10.1055/s-2007-995633
6 DIXON M F , GENTA R M , YARDLEY J H et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994[J]. Am J Surg Pathol, 1996, 20 (10): 1161- 1181
doi: 10.1097/00000478-199610000-00001
7 LI Z , ZUO X L , LI C Q et al. New classification of gastric pit patterns and vessel architecture using probe-based confocal laser endomicroscopy[J]. J Clin Gastroenterol, 2016, 50 (1): 23- 32
doi: 10.1097/MCG.0000000000000298
8 颜虹, 徐勇勇, 赵耐青 . 医学统计学[M]. 北京: 人民卫生出版社, 2010: 232- 236
YAN Hong , XU Yongyong , ZHAO Naiqing . Medical Statistics[M]. Beijing: People's Medical Publishing House, 2010: 232- 236
9 CORREA P . Human gastric carcinogenesis: a multistep and multifactorial process-first american cancer society award lecture on cancer epidemiology and prevention[J]. Cancer Res, 1992, 52 (24): 6735- 6740
10 DE VRIES A C , VAN GRIEKEN N C , LOOMAN C W et al. Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands[J]. Gastroenterology, 2008, 134 (4): 945- 952
doi: 10.1053/j.gastro.2008.01.071
11 DINIS-RIBEIRO M , AREIA M , DE VRIES A C et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED)[J]. Endoscopy, 2012, 44 (1): 74- 94
12 ESHMURATOV A , NAH J C , KIM N et al. The correlation of endoscopic and histological diagnosis of gastric atrophy[J]. Dig Dis Sci, 2010, 55 (5): 1364- 1375
doi: 10.1007/s10620-009-0891-4
13 LEE J Y , KIM N , LEE H S et al. Correlations among endoscopic, histologic and serologic diagnoses for the assessment of atrophic gastritis[J]. J Cancer Prev, 2014, 19 (1): 47- 55
14 KAMINISHI M , YAMAGUCHI H , NOMURA S . Endoscopic classification of chronic gastritis based on a pilot study by the research society for gastritis[J]. Dig Endosc, 2002, 14 138- 151
doi: 10.1046/j.1443-1661.2002.00199.x
15 CAZACU SM V C , BODRΜG N et al. The influence of risk factors to the prevalence of gastric mucosal atrophy, intestinal metaplasia and dysplasia in Oltenia region[J]. Curr Health Sci J, 2009, 35 98- 105
16 LIM J H , KIM N , LEE H S et al. Correlation between endoscopic and histological diagnoses of gastric intestinal metaplasia[J]. Gut Liver, 2013, 7 (1): 41- 50
doi: 10.5009/gnl.2013.7.1.41
17 PANTERIS V , NIKOLOPOULOU S , LOUNTOU A et al. Diagnostic capabilities of high-definition white light endoscopy for the diagnosis of gastric intestinal metaplasia and correlation with histologic and clinical data[J]. Eur J Gastroenterol Hepatol, 2014, 26 (6): 594- 601
doi: 10.1097/MEG.0000000000000097
18 SATO H , INOUE H , HAYEE B et al. In vivo histopathology using endocytoscopy for non-neoplastic changes in the gastric mucosa: a prospective pilot study (with video)[J]. Gastrointest Endosc, 2015, 81 (4): 875- 881
doi: 10.1016/j.gie.2014.08.019
19 DINIS-RIBEIRO M , DA COSTA-PEREIRA A , LOPES C et al. Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia[J]. Gastrointest Endosc, 2003, 57 (4): 498- 504
doi: 10.1067/mge.2003.145
20 AREIA M , AMARO P , DINIS-RIBEIRO M et al. External validation of a classification for methylene blue magnification chromoendoscopy in premalignant gastric lesions[J]. Gastrointest Endosc, 2008, 67 (7): 1011- 1018
doi: 10.1016/j.gie.2007.08.044
21 KIKUSTE I , MARQUES-PEREIRA R , MONTEIRO-SOARES M et al. Systematic review of the diagnosis of gastric premalignant conditions and neoplasia with high-resolution endoscopic technologies[J]. Scand J Gastroenterol, 2013, 48 (10): 1108- 1117
doi: 10.3109/00365521.2013.825315
22 SONG J, ZHANG J, WANG J, et al. Meta-analysis: narrow band imaging for diagnosis of gastric intestinal metaplasia[J/OL]. PLoS One, 2014, 9(4): e94869.
23 GONZáLEZ C A , SANZ-ANQUELA J M , COMPANIONI O et al. Incomplete type of intestinal metaplasia has the highest risk to progress to gastric cancer: results of the Spanish follow-up multicenter study[J]. J Gastroenterol Hepatol, 2016, 31 (5): 953- 958
doi: 10.1111/jgh.13249
24 GONZALEZ C A , SANZ-ANQUELA J M , GISBERT J P et al. Utility of subtyping intestinal metaplasia as marker of gastric cancer risk. A review of the evidence[J]. Int J Cancer, 2013, 133 (5): 1023- 1032
doi: 10.1002/ijc.28003
[1] 沈宏,季峰. 无X射线监视内镜下消化道支架置入治疗消化道狭窄的疗效和安全性[J]. 浙江大学学报（医学版）, 2018, 47(6): 643-650.
[2] 向一郎,吴子衡,张鸿坤. 胸主动脉覆膜支架原位开窗技术的应用现状[J]. 浙江大学学报（医学版）, 2018, 47(6): 617-622.
[3] 狄晨红,金帆. 密封蛋白4与高危型人乳头瘤病毒联合检测对于高级别鳞状上皮内病变及宫颈鳞癌的诊断价值[J]. 浙江大学学报（医学版）, 2018, 47(4): 344-350.
[4] 吴超,陈国仙,赵刘阳,李曙,洪云. PeriCam PSI血流灌注成像系统在脑缺血再灌注动物模型中的应用及评价[J]. 浙江大学学报（医学版）, 2018, 47(1): 51-56.
[5] 祝子逸,郦志军,何正富,王云震. 内镜引导下吻合口瘘冲洗治疗食管胃吻合口瘘合并瘘旁脓肿临床疗效观察[J]. 浙江大学学报（医学版）, 2017, 46(6): 637-642.
[6] 叶红柔 等. 双气囊小肠镜和多层螺旋CT对小肠肿瘤的诊断价值[J]. 浙江大学学报（医学版）, 2017, 46(5): 557-562.
[7] 徐芳英 等. 神经内分泌分化在胃腺癌进展及患者预后中的意义[J]. 浙江大学学报（医学版）, 2016, 45(1): 24-30.
[8] 岑超等. 纳秒脉冲电场肿瘤电消融的分子生物学机制[J]. 浙江大学学报（医学版）, 2015, 44(6): 678-683.
[9] 邹文斌, 杨帆, 李兆申. 中国胃癌诊治关键在于提高早期诊断率[J]. 浙江大学学报（医学版）, 2015, 44(1): 9-14,53.
[10] 王侃，等. 美国胃肠病协会首届中国学术论坛精要[J]. 浙江大学学报（医学版）, 2014, 43(6): 728-730.
[11] 潘志敏，等. 下腰椎精准微创技术的现状及展望[J]. 浙江大学学报（医学版）, 2014, 43(6): 711-716.
[12] . RNA干扰突变型p53基因对胃癌SGC7901细胞生物学行为的影响[J]. 浙江大学学报（医学版）, 2012, 41(3): 281-288.
[13] . 血清蛋白质质谱与支持向量机模型在胰腺癌检测上的应用[J]. 浙江大学学报（医学版）, 2012, 41(3): 289-297.
[14] . 胃复安对胶囊内镜检查影响的临床研究[J]. 浙江大学学报（医学版）, 2012, 41(2): 206-209.
[15] . 双气囊内镜在103例不明原因消化道出血诊断中的价值[J]. 浙江大学学报（医学版）, 2012, 41(1): 99-104.