亮蓝光成像与联动成像在早期食管癌内镜诊断中的应用价值

Diagnostic value of blue light imaging‑bright and linked color imaging for early esophageal cancer

摘要:

目的 评价亮蓝光成像（blue light imaging‑bright，BLI‑bright）和联动成像（linked color imaging，LCI）用于早期食管癌内镜诊断中的临床价值。方法 采用回顾性队列研究，以2018年5月—2020年8月在福建中医药大学附属福鼎医院行内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗，术前使用了蓝激光胃镜3种模式［BLI‑bright、LCI和白光成像（white light imaging，WLI）］进行详细检查，且ESD术后病理证实为早期食管癌的63例连续病例作为观察对象。主观可视性分析由6名内镜医师完成，按年资分成高年资组和低年资组，每组各3名，主要观察指标为可视性评分（ranking score，RS）。客观色差分析主要比较3种模式下早期食管癌癌灶与周边黏膜的总色差（ΔE），色差采用国际照明委员会的1976 L*a*b*系统。结果 6名研究者的RS总体评分WLI模式下为（2.57±0.81）分，明显低于LCI模式下的（3.25±0.67）分（t=9.71，P<0.001）和BLI‑bright模式下的（3.18±0.67）分（t=9.31，P<0.001）。亚组分析发现：高年资组的RS评分WLI模式下为（2.71±0.80）分，明显低于LCI模式下的（3.33±0.66）分（t=7.16，P<0.001）和BLI‑bright模式下的（3.42±0.62）分（t=8.09，P<0.001）；低年资组的RS评分WLI模式下为（2.40±0.90）分，亦明显低于LCI模式下的（3.15±0.83）分（t=9.62，P<0.001）和BLI‑bright模式下的（2.89±0.92）分（t=5.69，P<0.001），且LCI模式下评分还明显高于BLI‑bright模式（t=4.07，P<0.001）。WLI模式下早期食管癌癌灶与周边黏膜的ΔE为11.52±3.40，明显低于LCI模式下的16.64±4.70（t=7.10，P<0.001）和BLI‑bright模式下的15.72±3.84（t=7.88，P<0.001）。结论 与WLI模式相比，应用BLI‑bright模式和LCI模式都能增加早期食管癌癌灶与周边黏膜的色差，提高早期食管癌可视性。其中，LCI模式更有利于低年资内镜医师检出早期食管癌。

Abstract:

Objective To investigate the diagnostic value of blue light imaging‑bright (BLI‑bright) and linked color imaging (LCI) for early esophageal cancer (EEC). Methods Data of 63 consecutive patients with EEC who underwent gastroscopy under BLI‑bright, LCI and white‑light imaging (WLI) and endoscopic submucosal dissection (ESD) from May 2018 to August 2020 at Fuding Hospital Affiliated to Fujian University of Traditional Chinese Medicine were analyzed retrospectively in the cohort study. Subjective visibility analysis was performed by 6 endoscopists who were divided into 2 groups (expert group and trainee group) with 3 endoscopists in each group. The main observation index was the visibility score (ranking score, RS). The objective color difference (ΔE) between lesions of EEC and surrounding mucosa under 3 modes were analyzed by using the L*a*b* color space. Results The overall RS of 6 endoscopists under WLI mode (2.57±0.81) was significantly lower than that under LCI (3.25±0.67) (t=9.71, P<0.001) and BLI‑bright (3.18±0.67) (t=9.31, P<0.001). In the expert group, the RS of WLI (2.71±0.80) was significantly lower than that of LCI (3.33±0.66) (t=7.16, P<0.001) and BLI‑bright (3.42±0.62) (t=8.09, P<0.001). In the trainee group, the RS of WLI (2.40±0.90) was also significantly lower than that of LCI (3.15±0.83) (t=9.62, P<0.001) and BLI‑bright (2.89±0.92) (t=5.69, P<0.001), and the RS of LCI was higher than that of BLI‑bright (t=4.07, P<0.001). The ΔE between lesions of EEC and surrounding mucosa under WLI (11.52±3.40) was significantly lower than that under LCI (16.64±4.70) (t=7.10, P<0.001) and BLI‑bright (15.72±3.84) (t=7.88, P<0.001). Conclusion BLI‑bright and LCI can effectively improve EEC visibility and color difference between EEC and surrounding mucosa. Furthermore, LCI is more conducive to the detection of EEC for the trainees.