高清胃镜下早期胃癌筛检策略初探

A screening strategy for early gastric cancer under high-definition gastroscopy

摘要:

目的 初步总结高清胃镜下早期胃癌的筛检策略。方法 对2013年1月—2020年1月期间于解放军总医院第七医学中心行高清晰度胃镜检查且术后病理证实为早期胃癌或胃高级别上皮内瘤变（high grade intraepithelial neoplasia，HGIN）的469处病灶的胃镜图像进行重新判读，分析患者幽门螺杆菌（Helicobacter pylori，HP）感染状态，病灶是否位于萎缩区域内、是否位于贲门部、形态学类型、有无清晰边界、边界是否规则、病灶颜色等信息，总结早期胃癌和胃HGIN在高清胃镜下的形态学规律。 结果 469处早期胃癌或HGIN中，无HP感染史的病灶占2.1%（10/469），溃疡型病灶占7.7%（36/469）。可疑HP感染的非溃疡型病灶（423处）中，萎缩区域外病灶57处，其中贲门部病灶共28处，白光内镜下呈红色调者占82.1%（23/28）；非贲门部病灶共29处，具有清晰边界或白光内镜下呈白色调者占82.8%（24/29）；萎缩区域内病灶366处，其中隆起型病灶共73处，具有清晰边界或顶部有不规则凹陷者占95.9%（70/73）；平坦/凹陷型病灶共293处，边界不规则或窄带光成像下呈茶褐色调者占90.8%（266/293）。结论 根据胃内有无HP感染、病灶发生的部位和形态学类别的不同，以上内镜下形态特征可以作为高清胃镜下发现早期胃癌和HGIN的线索。

Abstract:

Objective To propose a strategy for detecting early gastric cancer (EGC) under high-definition gastroscopy. Methods Data of 469 lesions of EGC or high grade intraepithelial neoplasia (HGIN) confirmed by pathology detected at The Seventh Medical Center of Chinese People"s Liberation Army General Hospital from January 2013 to January 2020 were collected and gastroscopic images were re-interpreted. The Helicobacter pylori (HP) infection status, lesion location in the area of atrophy or at the cardia, morphological type of lesions, lesions with/without clear or regular boundary, and lesion color were analyzed for morphological characteristics of EGC and HGIN under high-definition gastroscopy. Results Among the 469 lesions of EGC or HGIN, HP-negative lesions accounted for 2.1% (10/469) and ulcerative lesions for 7.7% (36/469). Among non-ulcerative lesions of suspected HP infection (n=423), there were 28 lesions in the cardia outside the atrophic area and 82.1% (23/28) were reddish under white light imaging. There were 29 non-cardiac lesions outside the atrophic area and 82.8% (24/29) were white or showed clear border under white light imaging. Inside the atrophic area, there were 73 elevated lesions, 95.9% (70/73) of which had clear border or irregular depression on the top. There were 293 flat/depressed lesions in the atrophic area, and 90.8% (266/293) had irregular border or were brown under narrow band imaging. Conclusion According to the status of HP infection, the location and morphological category of lesions, above endoscopic features can be used as clues to detect EGC and HGIN.