| Background and ObiectivesGastroscopy is an indispensable method for diagnosis and treatment of digestive tract diseases.With the increase of its use,the limitations of traditional endoscopy in the detection and differentiation of minor and subtle lesions have been emphasized.The term "image-enhanced endoscopy" includes various means of improving contrast by using dyes and optical or electronic technologies.Among various IEE techniques,dye-stained endoscopes have been a traditional and most popular method for detecting lesions or sketching tumor profiles since the 1980s,because it increases the irregularities of mucosa and the difference in surface color.Another new IEE technology is electronic color endoscopy,which can obtain enhanced images digitally by various image processing techniques,thus eliminating the need of spraying dyes on mucous membranes.Among these electronic color endoscopy methods,NBI is one of the most widely used methods in clinical practice,and its practicability has been verified and verified in many experiments.At present,the clinical application of gastrnc NBI has been extended to include the detection and diagnosis of various lesions.At present,there are many retrospective studies on the accuracy of magnifying endoscopy combined with narrowband imaging(magnifying endoscopy and narrow band imaging ME-NBI)in the diagnosis of early gastric cancer(early gastric cancer EGC).But there are fewer prospective studies,Moreover,there are few studies on the influential factors of differential diagnosis and the value of ME-NBI in the diagnosis of gastric intraepithelial neoplasia.Based on this,a prospective study was carried out to study the diagnostic value of ME-NBI in EGC and GIN,and the influencing factors of the difference in diagnosis.Materials and Methodsanalysising of gastroscopy in the second affiliated Hospital of Zhengzhou University from December 2017 to January 2019.There were 91 cases of gastric intraepithelial neoplasia and early gastric cancer diagnosed by ME-NBI,including 27 cases of LGIN,21 cases of HGIN,39 cases of EGC and 4 cases of inflammation.Sex,age,lesion site,surface morphology,family history and microscopic diagnosis were collected from all the patients involved in the study.ResultsThe sensitivity,specificity and accuracy of ME in the diagnosis of LGIN were 40.74%,75.00%and 64.84%,respectively,according to the pathological results after ESD or EMR as the gold standard.The sensitivity,specificity and accuracy of ME-NBI in the diagnosis of LGIN were 66.67%,85.94%and 80.22%,respectively.There was no significant difference in sensitivity and specificity between ME and ME-NBI in the diagnosis of LGIN(?2 =3.650 P=0.056;?2 =2.436 P=0.119).Compared with the accuracy of LGIN diagnosis,the difference between ME and ME-NBI was statistically significant.(x2 =5.405 P=0.020).The sensitivity,specificity and accuracy of ME in the diagnosis of HGIN were 47.62%,77.14%and 70.33%,respectively.According to the pathological results after ESD or EMR,the sensitivity,specificity and accuracy were 47.62%,77.14%and 70.33%,respectively.The sensitivity,specificity and accuracy of ME-NBI in the diagnosis of HGIN were 76.19%,92.86%and 89.01%,respectively.Comparing the sensitivity and accuracy of HGIN diagnosis,the difference between ME and ME-NBI is statistically significant(x2 =6.690 P=0.010;?2 =9.804 P=0.002).There was no significant difference in the specificity between ME and ME-NBI in the diagnosis of HGIN(x2 =3.086 P=0.079).The sensitivity,specificity and accuracy of ME in the diagnosis of EGC were 48.72%,92.31%,73.63%,respectively.The sensitivity,specificity and accuracy of ME-NBI in the diagnosis of EGC were 82.05%,92.31%,87.91 respectively.There was no significant difference in sensitivity between ME-NBI and ME in the diagnosis of EGC(?2 =0.088 P=0.766).The difference of specificity and accuracy between ME-NBI and ME was statistically significant.(x 2 =4.940 P=0.026;x 2 =5.978 P=0.014)?The Kappa values of ME,ME-NBI and postoperative pathological diagnosis were 0.248 and 0.631,respectively.It is suggested that the diagnosis of ME is less consistent with the postoperative histopathological results,but the diagnosis of ME-NBI is better than that of ME.The consistent rate of diagnosis between ME and pathological diagnosis after ESD or EMR was 40.74%(11/27),38.46%(10/26),82.61%(19/23)respectively.There was a significant difference in the concordance rate of ME between three different grades of diagnosis and postoperative pathological diagnosis(?2= 11.916 P = 0.003).The coincidence rates between ME-NBI and pathological diagnosis after ESD or EMR were 66.67%(18/27),76.19%(16/21)and 88.89%(32/36)respectively.There was no significant difference in the concordance rate among the three different grades(?2 = 4.620 P = 0.099).The presence of secretions(P<0 05).?the location of the lesion(P<0 05)and HP infection(P<0 05)were the influencing factors of the difference in the diagnosis of ME-NBI.On the other hand,age(P>0.05 P = 0.446),surface color(P>0.05 P ?0.228),surface shape(P>0.05 P = 0.583),diameter of lesion(P>0.05 P = 0.130).The appearance of naked eye(P>0.05 P=0.224)is not the influencing factor of the difference in the diagnosis of ME-NBI.There was a significant difference in the diagnosis of differentiated and undifferentiated gastric cancer with ME-NBI(P<0 05).Conclusions1.The diagnostic value of ME-NBI for GIN and EGC is higher than that for ME.2.The presence of secretions,lesion location and HP infection were the influencing factors of the difference in diagnosis of ME-NBI(P<0 05).However,age,surface color,surface morphology,diameter of lesion and naked eye shape were not the influencing factors for the diagnosis difference of ME-NBI.3.Compared with differentiated EGC,ME-NBI has poor diagnostic value in undifferentiated EGC. |
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