| Background and aimsMucosa-associated lymphoid tissue lymphoma or extranodal marginal zone B-cell lymphoma is one of the most common lymphomas originating in the gastrointestinal tract,of which gastric MALT lymphoma is also known in the stomach.Gastric MALT lymphoma is a low-grade malignancy with a potential risk of conversion to highly malignant lymphoma(diffuse large B-cell lymphoma).Studies have shown that the incidence of gastric MALT lymphoma is closely related to the infection of Helicobacter pylori.About 90%of patients with gastric MALT lymphoma are tested for H.pylori infection and treated with anti-Helicobacter pylori eradication alone,Patients with MALT lymphoma have been completely relieved,and some patients with HP-negative or ineffective treatment for eradication of Helicobacter pylori will achieve good clinical results after radiotherapy or chemotherapy alone.Therefore,early diagnosis and early treatment are the primary problems in the treatment of gastric MALT lymphoma.However,the early diagnosis of gastric MALT lymphoma is difficult.Gastric MALT lymphoma is not typical in the general white light endoscopic,and it is difficult to distinguish it from chronic atrophic gastritis,peptic ulcer,diffuse large B-cell lymphoma and gastric cancer.In recent years,with the continuous advancement of endoscopic techniques,more and more advanced endoscopic techniques have been applied in clinical applications,such as endoscopic ultrasound,confocal laser endoscopy(CLE),and narrow-band imaging(NBI).It can clearly distinguish the fine structure of gastric mucosa,visually showing the depth and extent of infiltration of the lesion,can improve the accuracy of endoscopy and biopsy,thereby improving the detection rate of gastric MALT lymphoma.It has high sensitivity and specificity for the diagnosis of gastric MALT lymphoma.The optical enhancement endoscope(OE)was developed by Pentax,Japan.Similar to the NBI endoscope,a new type of pre-filter is placed at the front of the endoscope to achieve narrow-band imaging.The new optical filter delivers a higher overall transmittance by connecting the peaks of the hemoglobin absorption spectra(415 nm,540 um and 570 nm),resulting in a continuous wavelength spectrum.Thanks to the new filter technology,OE has a brighter field of view than NBI,even in the fully inflated gastrointestinal tract,there is still a brighter sight.Previous studies have shown that OE combined with magnifying endoscopy has a good application value in the diagnosis of early gastrointestinal cancer,intestinal metaplasia,and colon polyps.However,there is still no research on the diagnostic value of OE combined with magnifying endoscopy in gastric mucosa-associated lymphoid tissue lymphoma.In this study,we investigated the morphological features of gastric MALT lymphoma under endoscopic OE and OE combined with magnifying endoscopic,and evaluated the sensitivity,specificity,positive predictive value,and negative predictive vlue of OE endoscopic system in the diagnosis of gastric MALT lymphoma.At the same time,the diagnostic accuracy of white endoscopic and OE combined magnifying endoscopy for gastric MALT lymphoma was evaluated under the same level of endoscopic physicians,and the clinical value of OE combined with magnifying endoscopy in the diagnosis of gastric MALT lymphoma was evaluated.Research methodsThis study was conducted from January 2017 to June 2019,the primary endoscopic physician applied general white light endoscopy to consider patients with gastric mucosa-associated lymphoid tissue lymphoma,all patients were from Qilu Hospital of Shandong University.RESULTS:A total of 38 patients with suspected gastric MALT lymphoma were included in the study,including 16 males and 22 females.The gastroscopic examination was performed according to the observation sequence of ordinary white light endoscope,OE endoscope and OE combined with magnifying endoscope,and the images were sequentially observed and photographed to obtain image information.After the endoscopy,the images were divided into 2 groups,white light endoscopy group and OE combined with magnifying endoscopy group.Two Senior endoscopy physician with rich experience in the diagnosis of gastric MALT lymphoma were randomly selected.The images was read to identify whether it was a gastric MALT lymphoma or not,and a diagnosis of "yes" or "no" was given,and then the accuracy of the two groups of diagnostic results was compared after the pathological results were returned.Data were analyzed by chi-square test,p<0.05 for the difference was statistically significant.Gastric MALT lymphoma has three characteristic features under OE combined with magnifying endoscopy:loss of crypt epithelial structure,balloon-like swelling of crypt epithelium,and tree like apperance(TLA).The sensitivity,specificity,positive predictive value,and negative predictive value of three characteristic manifestations for the diagnosis of gastric MALT lymphoma were calculated.Then combined,the whole positive group(tree like apperance(TLA)+,loss of crypt epithelial structure+,balloon-like swelling of crypt epithelium+,we call it group O);double positive group,can be divided into 3 groups,Group A(tree like apperance(TLA)+,loss of crypt epithelial structure+,balloon-like swelling of crypt epithelium-),group B(tree like apperance(TLA)+,balloon-like swelling of crypt epithelium+,loss of crypt epithelial structure-),group C(loss of crypt epithelial structure+,balloon-like swelling of crypt epithelium+,tree like apperance(TLA)-),Finally,the sensitivity,specificity,positive predictive value and negative predictive value of the diagnosis of gastric MALT lymphoma in group O,group A,group B and group C were calculated.Research resultComparative analysis of the diagnostic accuracy of white light endoscopy and OE combined with magnifying endoscopy for gastric MALT lymphoma,the result is,the senior endoscopy doctor judged 21 cases correctly,and judged 17 cases with error,the correct rate was 55.2%;OE combined with magnifying endoscopy group judged 30 cases correctly,8 cases were judged wrong,the correct rate was 78.9%.After statistical analysis,the OE combined with magnifying endoscopy group was better than the white light endoscopy group in the diagnosis of gastric MALT lymphoma,x2=4.828,P<0.05,the difference was statistically significant.It is proved that compared with white light endoscopy,optical enhanced endoscopy combined with magnifying endoscopy has a very significant advantage in the diagnosis of gastric MALT lymphoma,.The purpose of the application of OE combined with magnifying endoscopy to further diagnose and guide pathological biopsy,thereby reducing missed diagnosis and misdiagnosis.Three endoscopic performances(loss of crypt epithelial structure,balloon-like swelling of crypt epithelium,and TLA)on the diagnosis of gastric MALT lymphoma,the results is,the sensitivity,specificity,positive predictive value,and negative predictive value of TLA to gastric MALT lymphoma were 75%,70%,87.50%,and 50.00%,respectively.The sensitivity,specificity,positive predictive value,and negative predictive value of loss of crypt epithelial structure to gastric MALT lymphoma,respectively,67.86%,50%,79.17%,35.71%;the sensitivity,specificity,positive predictive value and negative predictive value of balloon-like swelling of crypt epithelium to gastric MALT lymphoma were 67.86%,50.00%,76.19%,29.41%,respectively.The sensitivity,specificity,positive predictive value,and negative predictive value of the three endoscopic features for gastric MALT lymphoma were 17.86%,50.00%,100%,and 100%,respectively.By comparison.it can be found that the sensitivity and positive predictive value of TLA positive for gastric MALT lymphoma are the highest,followed by the loss of crypt epithelial structure,and the balloon-like swelling of crypt epithelium has the worst predictive effect on gastric MALT lymphoma,while satisfying Three endoscopic features can be used to diagnose the diagnosis of gastric MALT lymphoma almost 100%.Similarly,three endoscopic features are negative can almost exclude gastric MALT lymphoma by 100%.Finally,the double positive group,(group A)tree like apperance(TLA)+,loss of crypt epithelial structure+,balloon-like swelling of crypt epithelium-,group B tree like apperance(TLA)+,balloon-like swelling of crypt epithelium+,loss of crypt epithelial structure group C(loss of crypt epithelial structure+,balloon-like swelling of crypt epithelium+,tree like apperance(TLA)-;the positive predictive value of group A was 100%,The positive predictive value of group B was 85.71%,and the positive predictive value of group C was 50%,indicating that the prediction of TLA and loss of crypt epithelial structure was superior to balloon-like swelling of crypt epithelium in gastric MALT lymphomaIn conclusionIn the diagnosis of gastric MALT lymphoma,OE combined with magnifying endoscopy is superior to white light endoscopy in the same endoscopic physician;loss of crypt epithelial structure,balloon-like swelling of crypt epithelium,and TLA are unique features of gastric MALT lymphoma,in which TLA has the highest positive predictive value for gastric MALT lymphoma,followed by loss of crypt epithelial structure and balloon-like swelling of crypt epithelium;Endoscopic lesions that meet these three characteristics can accurately predict gastric MALT lymphoma. |
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