| [Background] Gastric cancer is the most common digestive tumor in our countryMost of patients with gastric cancer were in advanced stage when they were diagnosed.,The 5-year survival rate was not high even they accepted surgical resection. Therefore,early detection, early diagnosis and early treatment of gastric cancer in China is very important. Endoscopy combined with pathological examination is the gold standard for the diagnosis of early gastric cancer.,but the coincidence of biopsy pathological result with the surgical or ESD pathological result was not so high.Recently,narrow band imaging magnifying endoscopy was widely used in clinical application ,because doctors can clearly observe the subtle structures and microvessels of gastric mucosa through NBI-ME.[Objective] 1 .To study the characteristics of background mucosa of early gastric cancer .2.To investigate the value of narrow band imaging-magnifying endoscopy targeted biopsy in the diagnosis of early gastric cancer.[Methods] 1 .All data of 40 patients with early gastric cancer and 40 patients with atrophic gastritis selected from Sept 2015 to Jul 2016 in our hospital were analyzed prospectively. All patients were accepted serological examination,endoscopy and systematic biopsy, according to serologic,endoscopic and pathological findings,investigate the characteristics of early background mucosa.2. 67 patients' data with gastric lesions under narrow band imaging endoscopic in our hospital were collected from Jun 2013 to Sep. 2015. All patients were accepted white light endoscopy examination, and endoscopic performance was still highly suspected to be early gastric cancer.Then all of these patients accepted NBI-ME examination and targeted biopsy.Then all patients received surgical or endoscopic resection. Taking findings of the pathology as the gold standard, the diagnostic accuracy of WLE biopsy was compared with NBI-ME guide targeted biopsy.[Results] 1.The infection rates of Hp in early gastric cancer group and atrophic gastritis group were 50% and 27.5%.And the infection rates of Hp in none-to-mild EGA and moderate-to-severe EGA were 14.71% and 56.52%.According to the Japanese "ABC"method as the standard analysis,early gastric cancer group:A group of 20 cases,B group of 20 cases;atrophic gastritis group:A group of 28 cases,B group of 12 cases;we were not found C group and D group.According to the new "ABC" method as the standard analysis,early gastric cancer group:A group of 34 cases,B group of 6 cases;atrophic gastritis group:A group of 35 cases,B group of 5 cases;we were not found Cgroup.For patients with early gastric cancer or atrophic gastritis, the proportions of moderate-to-severe EGA were 72.5% and 42.5% respectively, while the proportions of OLGA ?-? were 35% and 10% respectively, and that of OLGIM ?-? were 25 %and zero respectively. The infection rate of Helicobacter pylori was significantly increased in moderate to severe EGA (56.52% vs 14.71%).And the OLGA / OLGIM staging was significantly related to EGA classification.2.Among 67 cases collecteded in the study, there were 34 cases of early gastric cancer, 24 cases of high-grade intraepithelial neoplasia, 8 cases of low-grade intraepithelial neoplasia,one case of gastritis. According the postoperative pathologic, the specificity,diagnostic sensitivity and coincidence rate of WLE biopsy and NBI-ME target biopsy were 53.73% and 72.41%,48.28%, 88.89%, 77.78%, 73.13%,respectively. The sensitivity and coincidence rates of NBI-ME target biopsy were significantly higher than the WLE biopsy in the diagnosis of early gastric cancer(P < 0.05), the specificity of the two methods had no significant statistical difference (P > 0.05).The positive rate of diagnosis has nothing to do with age,gender,location of the lesion and endoscopic classification.[Conclusions] 1. Patients with moderate to severe EGA staging or OLGA/OLGIM high risk staging had higher risk of gastric cancer.Endoscopists should be much more slowly and carefully and do more biopsy during the endoscopic examination to prevent missing lesions for these patients.And these patients should be followed up more closely.2.For patients with suspicious gastric lesions through white light endoscopy examinations should receive narrow band imaging-magnifying endoscopy examinations and targeted biopsy. NBI-ME targeted biopsy can help us to promote the detection rate of early gastric cancer. |
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