探讨窄带成像技术结合放大胃镜(narrow band imaging-magnifying endoscopy，NBI-ME)及内镜活检在早期胃癌及癌前病变诊断中的价值及差异。

收集2016年3月至2016年6月于潍坊医学院附属医院胃镜室行普通白光内镜(white light endoscopy，WLE)疑有早期胃癌或癌前病变的患者共50例，NBI-ME模式下观察胃小凹开口形态，并做出内镜下诊断，于病变最明显处取活检行病理检查，所有患者均行内镜黏膜下剥离术(endoscopic submucosal dissection，ESD)或外科手术治疗。对NBI-ME下的胃腺管开口形态与术后切除病理结果进行分析，并将NBI-ME及内镜活检的诊断结果与术后大体病理结果进行对比分析。

胃黏膜腺管开口的形态与术后病理诊断比较之间差异具有统计学意义(χ²＝42.13，P<0.05)。NBI-ME对低级别上皮内瘤变(low-grade intraepithelial neoplasia，LGIN)诊断的灵敏度与内镜活检比较，差异具有统计学意义(P＝0.02)，而对LGIN诊断的特异度、准确率比较，NBI-ME与内镜活检之间的差异无统计学意义(P>0.05)。NBI-ME对早期胃癌诊断的灵敏度、特异度、准确率与内镜活检比较，差异无统计学意义(P>0.05)。NBI-ME、内镜活检与术后病理诊断进行一致性检验的Kappa值分别为0.54、0.64(P<0.05)。

NBI-ME对早期胃癌及癌前病变的诊断有较高的临床应用价值，但与病理活组织检查结果相比仍存在差异；NBI-ME可对内镜准确活检提供较大帮助。

To explore the value and difference of narrow band imaging-magnifying endoscopy(NBI-ME)and endoscopic biopsy in the diagnosis of early gastric cancer and precancerous lesions.

Fifty patients with suspicious early gastric lesions or precancerous lesions as revealed by white light endoscopy(WLE)were enrolled in the study from March 2016 to June 2016 in Affiliated Hospital of Weifang Medical University.All lesions were observed through NBI-ME, and the types of crypt-opening were recorded to give a diagnosis.Biopsy specimens were then taken from suspicious lesions for pathological examination.All patients received endoscopic submucosal dissection(ESD)or surgical intervention.The types of crypt-opening were analyzed in combination with postoperative pathological diagnosis.The diagnosis of NBI-ME and endoscopic biopsy and postoperative pathological diagnosis were compared and analyzed.

There was significant difference in the type of crypt-opening and the postoperative pathological diagnosis(χ²=42.13, P<0.05). The sensitivity of NBI-ME for diagnosing low-grade intraepithelial neoplasia(LGIN)was significantly lower than that of endoscopic biopsy(P=0.02), but there was no statistical difference in diagnostic specificity and accuracy between the two modalities(P>0.05). The differences of sensitivity, specificity and accuracy between NBI-ME and endoscopic biopsy in the diagnosis of early gastric cancer were not statistically significant(P>0.05). The Kappa values of the consistency checks were 0.54(NBI-ME and postoperative pathological diagnosis)and 0.64(endoscopic biopsy and postoperative pathological diagnosis), with a statistically significant difference(P<0.05).

NBI-ME has a high clinical value in the diagnosis of early gastric cancer and precancerous lesions, but there are still differences compared with the results of pathological biopsy.NBI-ME can provide a great help to accurate endoscopic biopsy.