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窄带成像-放大内镜和超声内镜诊断结直肠黏膜下癌的价值及特异性影像特征

Value of narrow band imaging-magnifying endoscopy and endoscopic ultrasonography in diagnosing colorectal submucosal carcinoma and its specific imaging features

    摘要
  • 摘要:
    目的 探讨窄带成像-放大内镜(NBI-ME)和超声内镜(EUS)诊断结直肠黏膜下癌的价值, 并分析黏膜下癌的特异性影像特征。
    方法 选取259例早期结直肠癌患者作为研究对象，患者均接受NBI-ME和EUS检查。分析NBI-ME、EUS检查结果与病理诊断结果的一致性，评估NBI-ME、EUS单独及联合应用对黏膜下癌的诊断效能，并比较黏膜下癌与黏膜内癌患者的临床特征及影像特征差异。
    结果 259例患者中，黏膜内癌患者203例，黏膜下癌患者56例。NBI-ME、EUS对肿瘤浸润情况的判断结果与病理诊断结果均具有良好一致性(Kappa=0.706、0.685, P < 0.001)。NBI-ME联合EUS诊断黏膜下癌的灵敏度、阴性预测值均高于NBI-ME、EUS单独诊断，但特异度低于NBI-ME、EUS单独诊断，差异有统计学意义(P < 0.05)。黏膜下癌患者中病变最大径>2 cm、病灶易出血、血管扩张者占比分别为71.43%、46.43%、39.29%, 高于黏膜内癌患者的41.87%、28.57%、10.34%, 差异有统计学意义(P < 0.05)。多因素Logistic回归分析结果显示，病变最大径>2 cm、病灶易出血和血管扩张均为黏膜下癌的独立危险因素(P < 0.05)。
    结论 NBI-ME和EUS在诊断结直肠黏膜下癌与黏膜内癌方面具有一定应用价值，且两者联合应用的诊断效能更佳。病变最大径>2 cm、病灶易出血和血管扩张的早期结直肠癌患者，被诊断为黏膜下癌的风险较高。

     

    Abstract:
    Objective To investigate the value of narrow band imaging-magnifying endoscopy (NBI-ME) and endoscopic ultrasonography (EUS) in diagnosing colorectal submucosal carcinoma and to analyze the specific imaging features of submucosal carcinoma.
    Methods A total of 259 patients with early-stage colorectal cancer were selected as study subjects. All patients underwent NBI-ME and EUS examinations. The consistency between the results of NBI-ME, EUS, and pathological diagnosis was analyzed. The diagnostic efficacy of NBI-ME, EUS alone, and their combined application for submucosal carcinoma was evaluated. The differences in clinical and imaging features between patients with submucosal carcinoma and intramucosal carcinoma were compared.
    Results Among 259 patients, 203 had intramucosal carcinoma and 56 had submucosal carcinoma. The judgments of tumor infiltration by NBI-ME and EUS showed good consistency with the pathological diagnosis results (Kappa=0.706, 0.685, respectively, P < 0.001). The sensitivity and negative predictive value of NBI-ME combined with EUS in diagnosing submucosal carcinoma were higher than those of NBI-ME or EUS alone, while the specificity was lower, with statistically significant differences (P < 0.05). The proportions of patients with submucosal carcinoma having a lesion maximum diameter>2 cm, easily bleeding lesions, and vascular dilation were 71.43%, 46.43%, and 39.29%, respectively, which were higher than those in patients with intramucosal carcinoma (41.87%, 28.57%, and 10.34%, respectively) (P < 0.05). Multivariate Logistic regression analysis showed that a lesion maximum diameter >2 cm, easily bleeding lesions, and vascular dilation were all independent risk factors for submucosal carcinoma (P < 0.05).
    Conclusion NBI-ME and EUS have certain application value in diagnosing colorectal submucosal carcinoma and intramucosal carcinoma, and their combined application demonstrates better diagnostic efficacy. Patients with early-stage colorectal cancer having a lesion maximum diameter>2 cm, easily bleeding lesions, and vascular dilation are at a higher risk of being diagnosed with submucosal carcinoma.

     

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