目的:探讨电子喉镜窄带成像技术(NBI)在临床上用于下咽癌诊断的价值。方法:选取2019年2月至2021年12月于青岛大学附属医院耳鼻喉科门诊就诊可疑下咽病变的120例患者,每位患者均用白光和窄带成像模式的电子喉镜进行检查,取组织活检,以病理结果为金标准,评估两种模式在诊断下咽恶性肿瘤的敏感性、特异性和准确性。结果:120例患者中,确诊患者89例,白光模式敏感性、特异性和准确性分别为83.15%、74.19%、80.83%;NBI模式的敏感性、特异性和准确性分别为93.26%、83.87%、90.83%。NBI模式对下咽恶性肿瘤诊断的敏感性和准确性均高于白光模式,差异有统计学意义(P < 0.05),但两者对于下咽恶性肿瘤诊断的特异性差异无统计学意义(P > 0.05)。结论:电子喉镜窄带成像技术有助于提高下咽恶性肿瘤的早期发现,提升疾病的诊断率,有较好的临床应用价值。 Objective: To investigate the clinical value of narrow-band imaging (NBI) of electronic laryngoscope in the diagnosis of hypopharyngeal carcinoma. Methods: From February 2019 to December 2021, 120 patients with suspected hypopharyngeal lesions were selected from the Otolaryngology Department of Qingdao University Affiliated Hospital. Each patient was examined by electronic laryngoscopy in white light and narrow-band imaging modes, and tissue biopsy was taken. The pathological results were used as the gold standard to evaluate the sensitivity, specificity and accuracy of the two modes in diagnosing hypopharyngeal malignancies. Results: Among the 120 patients, 89 were diagnosed, the sensitivity, specificity and accuracy of white light mode were 83.15%, 74.19% and 80.83%, respectively; the sensitivity, specificity and accuracy of NBI mode were 93.26%, 83.87% and 90.83%. The sensitivity and accuracy of NBI mode in the diagnosis of hypopharyngeal malignant tumors were higher than those of white light mode, and the difference was statistically significant (P < 0.05), but there was no significant difference in specificity between the two in the diagnosis of hypopharyngeal malignant tumors (P > 0.05). Conclusion: Electronic laryngoscope narrow-band imaging technology can help improve the early detection of hypopharyngeal malignant tumors, improve the diagnosis rate of the disease, and has good clinical application value.
目的:探讨电子喉镜窄带成像技术(NBI)在临床上用于下咽癌诊断的价值。方法:选取2019年2月至2021年12月于青岛大学附属医院耳鼻喉科门诊就诊可疑下咽病变的120例患者,每位患者均用白光和窄带成像模式的电子喉镜进行检查,取组织活检,以病理结果为金标准,评估两种模式在诊断下咽恶性肿瘤的敏感性、特异性和准确性。结果:120例患者中,确诊患者89例,白光模式敏感性、特异性和准确性分别为83.15%、74.19%、80.83%;NBI模式的敏感性、特异性和准确性分别为93.26%、83.87%、90.83%。NBI模式对下咽恶性肿瘤诊断的敏感性和准确性均高于白光模式,差异有统计学意义(P < 0.05),但两者对于下咽恶性肿瘤诊断的特异性差异无统计学意义(P > 0.05)。结论:电子喉镜窄带成像技术有助于提高下咽恶性肿瘤的早期发现,提升疾病的诊断率,有较好的临床应用价值。
窄带成像,下咽癌,诊断
Deli Wang1, Xue Hou2, Jie Qiu1*
1Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong
2Department of Spleen and Stomach Diseases, Jimo District Hospital of Traditional Chinese Medicine, Qingdao Shandong
Received: Mar. 14th, 2022; accepted: Apr. 8th, 2022; published: Apr. 18th, 2022
Objective: To investigate the clinical value of narrow-band imaging (NBI) of electronic laryngoscope in the diagnosis of hypopharyngeal carcinoma. Methods: From February 2019 to December 2021, 120 patients with suspected hypopharyngeal lesions were selected from the Otolaryngology Department of Qingdao University Affiliated Hospital. Each patient was examined by electronic laryngoscopy in white light and narrow-band imaging modes, and tissue biopsy was taken. The pathological results were used as the gold standard to evaluate the sensitivity, specificity and accuracy of the two modes in diagnosing hypopharyngeal malignancies. Results: Among the 120 patients, 89 were diagnosed, the sensitivity, specificity and accuracy of white light mode were 83.15%, 74.19% and 80.83%, respectively; the sensitivity, specificity and accuracy of NBI mode were 93.26%, 83.87% and 90.83%. The sensitivity and accuracy of NBI mode in the diagnosis of hypopharyngeal malignant tumors were higher than those of white light mode, and the difference was statistically significant (P < 0.05), but there was no significant difference in specificity between the two in the diagnosis of hypopharyngeal malignant tumors (P > 0.05). Conclusion: Electronic laryngoscope narrow-band imaging technology can help improve the early detection of hypopharyngeal malignant tumors, improve the diagnosis rate of the disease, and has good clinical application value.
Keywords:Narrow-Band Imaging, Hypopharyngeal Carcinoma, Diagnosis
Copyright © 2022 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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下咽癌是头颈部常见的恶性肿瘤之一,约占头颈部恶性肿瘤的3%~4% [
选取2019年2月至2021年12月于青岛大学附属医院耳鼻喉科门诊就诊怀疑下咽恶性肿瘤的120例患者,纳入标准为可疑有下咽恶性肿瘤的患者。排除标准:一般情况较差,生命体征不平稳、对局麻药物过敏、无法理解和签署知情同意书的患者。其中男性98例,女性22例;年龄26~88岁,平均57岁。本研究经医学伦理委员会的批准。
120例患者均行电子喉镜检查,检查过程中使用普通白光和窄带成像两种模式。患者于检查前以浓度为1%的丁卡因喷施双侧鼻腔、咽后壁行表面麻醉,并于鼻腔内加喷呋麻滴鼻液。患者取平卧位,电子喉镜经一侧鼻腔进入,经由鼻咽、口咽到达喉咽,吸净分泌物后在普通白光模式和窄带成像模式下进行观察并保留高清图像,对可疑病变部位取活检,送至病理科行病理诊断。
由两名经验丰富的专业医师对电子喉镜下图像进行观察并给出诊断意见,对于存在不同意见的图像经研究讨论后得出统一结论,最终诊断以病理结果为金标准,对比两种不同模式下的诊断结果。
采用SPSS 24.0统计学软件对结果进行数据分析,计数资料以频数和百分比(%)表示,行χ2检验比较两种模式的差异,P < 0.05为差异有统计学意义。
在120例患者的电子喉镜结果中,于白光模式下考虑下咽癌的82例,良性病变38例;NBI模式下怀疑下咽癌的88例,良性病变32例。最终病理显示下咽癌89例,良性病变31例,见表1。
病理结果 | 例数 | 白光模式 | NBI模式 | |||
---|---|---|---|---|---|---|
恶性 | 良性 | 恶性 | 良性 | |||
恶性 | 89 | 74 | 15 | 83 | 6 | |
良性 | 31 | 8 | 23 | 5 | 26 | |
表1. 白光成像和NBI成像对下咽病变诊断与病理结果对比
图1. 电子喉镜白光模式和NBI模式图像对比
白光模式对下咽癌诊断的敏感性、特异性和准确性分别为83.15% (74/89)、74.19% (23/31)和80.83% (97/120);NBI模式对下咽癌诊断的敏感性、特异性和准确性分别为93.26% (83/89)、83.87% (26/31)和90.83% (109/120)。两种模式对于下咽癌诊断的敏感性和准确性差异有统计学意义(χ2 = 4.373、4.934, P < 0.05),但对于诊断的特异性,差异无统计学意义(χ2 = 0.876, P > 0.05),见表2。
组别 | 敏感性 | 特异性 | 准确性 |
---|---|---|---|
白光成像 | 83.15% | 74.19% | 80.83% |
NBI成像 | 93.26% | 83.87% | 90.83% |
χ2 | 4.373 | 0.876 | 4.934 |
P | 0.037 | 0.349 | 0.026 |
表2. 白光成像与NBI成像对下咽癌的诊断对比
下咽癌作为头颈部常见的恶性肿瘤之一,由于在解剖位置较深,下咽癌的隐蔽性很强。下咽癌的早期临床症状不明显,容易被忽视,多数患者确诊时往往多已发展至中晚期,病变范围较广,出现淋巴结转移甚至是远处的转移 [
电子喉镜窄带成像技术(NBI)利用滤光器过滤掉内镜光源所发出红蓝绿光波中的宽带光谱,选择415 nm的蓝光,540 nm的绿光。蓝光波长短,穿透黏膜表浅,能显示黏膜表面的表浅血管,血红蛋白对光波的吸收峰也在415 nm,可以很好的被血红蛋白吸收,能够清晰显示出粘膜表层的微小血管结构和形态。540 nm的绿光穿透力强,对于黏膜下层的血管显示效果好 [
在本研究中,选取于我院门诊就诊的120例患者行电子喉镜检查,分别采用白光模式及窄带成像模式对病变部位进行观察和诊断。结果显示:白光成像模式下咽癌诊断准确率80.83%,窄带成像模式下咽癌诊断的准确率90.83% (χ2 = 4.934, P < 0.05);两种检查模式敏感性对比,白光成像模式敏感性83.15%,窄带成像模式敏感性93.26% (χ2 = 4.373, P < 0.05);两种检查模式特异性性对比,白光成像特异性74.19%,窄带成像特异性83.87% (χ2 = 0.876, P > 0.05)。本研究表明电子喉镜窄带成像技术(NBI)在下咽癌的诊断过程中相较于白光模式在特异性方面没有明显差异,但是具有更高的准确性和敏感性,有助于下咽癌的早期发现和诊断,有较好的临床应用价值。
王得力,侯 雪,邱 杰. 电子喉镜窄带成像技术在下咽癌诊断中的应用Application of Electronic Laryngoscope Narrow-Band Imaging Technique in the Diagnosis of Hypopharyngeal Carcinoma[J]. 临床医学进展, 2022, 12(04): 2864-2868. https://doi.org/10.12677/ACM.2022.124411