| Background and objective: Gastric cancer is the worldwide incidence of malignant tumorswith higher mortality, compared with advanced gastric cancer, early gastric cancer cure rateof more than90%, and5-year survival of advanced gastric cancer is only about20to30percent. In recent years, studies have shown that gastric mucosal lesions occur in the gastricpits and mucosal micro-vascular inevitable morphological changes can significantly improvethe diagnostic rate of early gastric cancer by the narrow-band imaging and magnifyingendoscopy to observe the gastric pits and capillary pattern. The National Shikoku CancerCenter, magnifying endoscopy examination of318cases of patients,232cases found that thefoci, the results show that the result of magnifying endoscopy and histologic findings similarto the diagnostic sensitivity and specificity were96.0%and95.5%. At present, the type ofmagnifying endoscopy gastric pits and capillary pattern morphology is no unified andstandardized criteria, and domestic and international research groups selected sample volumeis small, results are difficult to unify. We apply the narrow-band imaging combined withmagnifying endoscopy to observe the change of154cases of gastric mucosal lesions ofgastric pits and capillary pattern, and were compared with pathological results, and to furtherexplore the narrow band imaging and clinical value of magnifying endoscopy forprecancerous lesions and early diagnosis of gastric cancer. Angiopoietin-2(Ang-2) is tostimulate specific angiogenic factor, is highly expressed only in malignant cells and thenumber of tumor angiogenesis and prognosis, specifically expressed in the redevelopmentarea of blood vessels in the tumor margin, involved in angiogenesis initiation and continuation of the process. Cyclooxygenase-2(COX-2) is the rate-limiting enzyme of thearachidonic acid synthesis of prostaglandin, a variety of pathophysiological processesinvolved in the body, almost no expression in normal tissues, except in inflammation andphysiological stimuli or growth factor-induced prostaglandins cause pain and inflammation,COX-2is also involved in a variety of tumor cell proliferation, anti-apoptosis andangiogenesis, and tumor invasion and metastasis. In this study,100cases of gastric mucosallesions, immunohistochemical detection of Ang-2, COX-2expression level analysis of itsrelationship with the pathological findings to explore the Ang-2, COX-2in gastric mucosalesions the expression level of clinical significance.Methods:154cases of patients with conventional gastroscopy center to collect the GeneralHospital of Ningxia Medical University from March2010to2011in December found thatlocal gastric mucosal lesions (erosion, abnormal color, uplift, shallow depression, rough, etc.),the NBI-ME mode observation of the gastric pits and capillary pattern, respectively, thereference to the Sakaki type and the Gong Jun type of the lesion to judge the lesions biopsyfor pathological examination.15min in patients with oral lidocaine mortar10mloropharyngeal anesthesia before the examination and stomach defoaming. Normalgastroscopy mode into the mirror to the descending part of duodenum, the conventionalretreat microscope suspicious lesions after using the spray pipe "normal saline100ml anddimethicone oil4ml and sodium bicarbonate1g" formulated flushing fluid sprayed around thelesion10~20ml, eliminate mucus and bubbles attached to the mucosal surface, switch to theNBI-ME mode to observe the lesion shape, borders, and color differences in the surroundingarea, the manual zoom adjust the magnification to see the gastric pits and capillary patternsubject to observe the lesions of gastric pits and mucosal micro-vascular change in the initialparting evaluation. Completion of the inspection, the use of disposable biopsy forceps biopsyof suspicious lesions at a3to send the histopathological examination, the pathologicaldiagnosis by the hospital pathology the same high qualification pathologist. And application of immunohistochemical detection of100cases of gastric mucosa with chronic inflammation,dysplasia and gastric cancer tissue Ang-2, COX-2expression, analysis of Ang-2, COX-2indifferent gastric mucosa lesions the expression level of clinical significance.Results:(1) The narrow-band imaging, magnifying endoscopy to observe the gastric pitsmorphologic changes to diagnose precancerous lesions (intestinal metaplasia, mild-moderatedysplasia) and the detection rate of42.8%(66/154), the diagnosis of severe dysplasia andearly gastric cancer sensitivity of78.6%, specificity95.7%, the rate was94.2%; observationof micro-vascular diagnosis of severe dysplasia and early gastric cancer, a sensitivity of76.9%and a specificity of97.2%, in line with the rate of95.4%.(2)This group of patientswith endoscopic the ESD surgery or surgical pathology report confirmed severe dysplasia orcancer cells only infiltration of the mucosa and sub-mucosa, a total of14cases of severedysplasia and early gastric cancer detection rate of43.7%(14/32).(3)Ang-2in mucosalinflammation, dysplasia, gastric cancer patients positive rates were16.4%(9/55),42.3%(11/26),68.4%(13/19), the difference was statistically significant (P=0.000), the positiveexpression rate of gastric cancer group was significantly higher than mucosal inflammation(P=0.000); express no difference (P=0.107) and dysplasia group.(4)COX-2in mucosalinflammation, dysplasia, the positive rate of gastric cancer patients were74.5%(41/55),80.8%(21/26),89.5%(17/19), the difference was not statistically significant (x2=1.773,P=0.455). Group of gastric cancer and mucosal inflammatory group (P=0.213); dysplasiagroup (P=0.681).Conclusions:(1) The narrow-band imaging and magnifying endoscopy to observe the gastricpits and capillary pattern can increase the rate of diagnosis of precancerous lesions and earlygastric cancer.(2)Gastric pit patterns of reference Sakaki typeⅠand typeⅡis more commonin benign gastric mucosal lesion, type III is more common in intestinal metaplasia or milddysplasia; typeⅣandⅤtype more performance for light-moderate dysplasia, VI-type multi-theperformance of severe dysplasia and gastric cancer, gastric pit patterns more tend to disorder and destruction, the lesions are more tend to be malignant lesions.(3) capillary pattern withreference to the Gong Jun type, type I is prevalent in the mucosa with chronic inflammation orintestinal metaplasia, typeⅡlight, moderate or severe dysplasia or gastric cancer weredistributed, III mainly severe dysplasia or gastric cancer.(4)NBI-ME observation of thegastric pits and capillary pattern changes is still uncertain whether the judgment gastric cancerdepth of invasion.(5) Ang-2as a tumor marker of gastric cancer has a certain clinical value,when included in the screening of gastric cancer at high risk of, or will contribute to earlydetection and treatment of gastric cancer.(6) Gastric mucosal lesions (rough mucosa, erosions,abnormal color, bulge, or shallow ulcers, etc.) the detection of COX-2is not suitable for theabove-mentioned benign and malignant lesions to identify.(7) Ang-2positive expression ofthe gastric pits typing correlation of COX-2expression and gastric pit patterns was nosignificant correlation. |
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