NBI内镜对声带白斑病变性质的评估价值

Diagnosis Value of Narrow Band Imaging Endoscopy in Evaluating the Degenerative Properties of Vocal Cord Leukoplakia

王广明;王燕;许珍;周涛;屈季宁;华清泉

1:湖北省大冶市人民医院耳鼻咽喉头颈外科

2:武汉大学人民医院耳鼻咽喉头颈外科

摘要
目的 探讨窄带成像(narrow band imaging, NBI)内镜对声带白斑病变性质的评估价值。方法 回顾性分析95例(153侧)声带白斑患者(58例双侧,37例单侧)的临床资料,所有患者在显微喉镜手术前均进行电子喉镜检查,先用普通白光检查声带病变,再用NBI模式检查。根据NBI内镜下白斑及上皮内乳头样毛细血管袢(intraepithelial papillary capillary loop, IPCL)的形态特征,分为低危组(I型、II型、III型白斑)和高危组(IV型、V型、VI型白斑)。然后所有患者均于全麻支撑喉镜下行喉显微手术,术后切除的病变组织送病理检查,将NBI内镜评估结果与病理结果进行比较,计算NBI内镜评估病变性质的敏感性、特异性、准确性及Kappa-Cohen指数。结果 153侧病变中,根据NBI内镜,123侧病灶(80.4%)评估为低危组(I型18侧,II型41侧,III型64侧),可能为良性病变,30侧病灶(19.6%)评估为高危组(IV型2侧,V型25侧,VI型3侧),可能为恶性;病理结果示121侧(79.1%)为低危组(角化过度20侧,轻度不典型增生39侧,中度不典型增生62侧),32侧(20.9%)为高危组(重度不典型增生5侧,原位癌22侧,浸润癌5侧)。NBI内镜评估除低危组中有2侧III型病变病理检查为重度不典型增生外,其余均与病理结果相符合。NBI内镜预测白斑恶性程度的敏感性为100%,特异性为97.6%,阳性预测值为90%,阴性预测值为100%,准确性为98%,Kappa-Cohen指数为90%(95%置信区间82.3%~100%)(P<0.05)。结论 根据NBI内镜可较准确评估声带白斑的病变性质。
关键词
声带白斑;窄带成像;内镜
基金项目(Foundation):
作者
王广明;王燕;许珍;周涛;屈季宁;华清泉
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