Diagnostic Value Of Chemical Staining Combined With Blue Laser Magnifying Endoscopy For Early Gastric Cancer

Objective:At present,gastric cancer is still a malignant tumor with high morbidity and mortality in China,and the prognosis of gastric cancer is closely related to the timing of diagnosis and treatment.Early gastric cancer can be treated with radical surgery under endoscopy,the patient's cost is small,and the prognosis and quality of life are good.However,the endoscopic lesions of early gastric cancer are changeable,the characteristics are not obvious,and it is not easy to be found.As a result,most cancers have developed into advanced cancer when clinically discovered.Therefore,the early detection,early diagnosis and early treatment of gastric cancer have been the unremitting pursuit of the majority of clinicians.Magnifying endoscopy technology provides the potential for detection and diagnosis of early gastric cancer.A new generation of blue laser magnifying endoscopy with laser as the light source,which increases the brightness and contrast of endoscopic imaging compared with ordinary light sources.Blue laser endoscopy has been reported to have a stronger ability to diagnose early gastric cancer than NBI magnifying endoscopy.Traditional gastrointestinal staining technology is a long-established and mature technology,which can also improve the ability to reveal and highlight gastrointestinal lesions to a certain extent,thereby helping to detect gastrointestinal lesions early.The purpose of this study was to investigate whether blue laser magnification endoscopy combined with chemical staining can improve the diagnosis rate of early gastric cancer and precancerous lesions.Methods:Patients who came to our hospital from November 2018 to November 2019 were selected,and 108 lesions of 102 patients were collected according to the inclusion,exclusion,and inclusion criteria.Taking these lesions as the research object,all lesions were examined by WLE-ME,BLI-ME,and BLI-CE-ME.Endoscopic diagnosis based on diagnostic criteria(chronic gastritis,low-grade intraepithelial neoplasia / intestinal metaplasia,high-grade intraepithelial neoplasia / early stomach cancer).Using the pathological diagnosis results as the gold standard,find the total agreement(rate)of the endoscopic diagnosis and pathological diagnosis in each endoscopic examination mode.Then all the endoscopic examination results are classified as early gastric cancerous lesions and non-gastric early cancerous lesions,and the consistency(rate)of the endoscopic diagnosis and pathological diagnosis in each endoscopic examination mode is obtained.For the above two sets of data,the Kappa consistency test was used to evaluate the consistency of the endoscopic diagnosis and pathological diagnosis of the three endoscopic examination methods;the Mc Nemar paired chi-square test was used to compare the endoscopic diagnosis and pathological examination of the three endoscopic examination methods.Statistical differences between diagnoses.Results:Among the 108 lesions studied,54 had chronic gastritis,36 had intestinal metaplasia / low neoplasia,and 18 had high neoplasia / early cancer.For three different types of gastric diseases,the total coincidence rates of endoscopic diagnosis and pathological diagnosis under the three endoscopy methods of WLE-ME,BLI-ME,and BLI-CE-ME were 62.0%,83.3%,91.7%,and Kappa value.0.351,0.727,0.864 respectively,the consistency of BLI-CE-ME is the best,obviously stronger than WLE-ME and BLI-ME.In the same way,for the comparison of the diagnosis of early gastric cancerous lesions,the coincidence rates of WLE-ME,BLI-ME,BLI-CE-ME three methods of microscopic diagnosis and pathological diagnosis were 27.8%,77.8%,88.9%,Kappa value Respectively 0.314,0.707,0.867,P values were 0.021,1.000,1.000.It can be seen that BLI-CE-ME has the best consistency and is significantly stronger than WLE-ME and BLI-ME.Under the standard of P <0.05,BLI-CE-ME can improve the early gastric cancerous lesions compared with WLE-ME Diagnostic rate.The sensitivity,specificity,positive predictive value,negative predictive value,and Youden index of the diagnosis of early gastric cancerous lesions and non-early cancerous lesions by BLI-CE-ME were the highest.Conclusions:1.For three different kinds of gastric diseases: the degree of conformity between the microscopic diagnosis and the gold standard(pathological diagnosis)is increasing from WLE-ME,BLI-ME to BLI-CE-ME;BLI-CE-ME mode mirror The following diagnosis has the strongest consistency with the gold standard and is stronger than WLE-ME and BLI-ME endoscopes.2.For early gastric cancerous lesions and non-early cancerous lesions: the conformity and consistency of microscopic diagnosis with the gold standard are increasing from WLE-ME,BLI-ME to BLI-CE-ME;under WLE-ME mode There is a statistical difference between the microscopic diagnosis and the gold standard.There is no statistical difference between the microscopic diagnosis in the BLI-ME and BLI-CE-ME modes and the gold standard.Under the standard of P <0.05,BLI-CE-ME can improve the diagnosis rate of early gastric cancerous lesions compared with WLE-ME.3.The comparison of the diagnostic capabilities of BLI-ME and BLI-CE-ME for the diagnosis of early gastric cancerous lesions: the P value of the comparison between the microscopic diagnosis and the pathological diagnosis gold standard is> 0.05,which is not statistically The above shows that BLI-CE-ME has a diagnostic advantage over BLI-ME for early gastric cancerous lesions.BLI-CE-ME mode has obvious advantages over WLE-ME mode in early gastric cancerous lesions and diagnosis;BLI-CE-ME mode has higher diagnostic consistency and consistency than BLI-ME mode,but the difference cannot be Statistics show that BLI-CE-ME is superior to BLI-ME in the diagnosis of early gastric cancerous lesions.