窄带成像技术下鼻咽癌黏膜微血管形态学变化分析

Mucosal microvascular morphological changes in nasopharyngealcarcinoma under narrow band imaging

摘要:

目的 探讨窄带成像技术（narrow band imaging，NBI）下鼻咽癌黏膜微血管形态的特征性表现。方法 选取我科2009年12月~2010年9月在门诊行电子鼻咽喉内镜检查，NBI模式下鼻咽局部疑为癌变并行活检的患者94例，根据局部是否隆起将上述患者分为平坦组与隆起组，计算NBI技术对上述两组患者鼻咽癌诊断的阳性预测值，并作统计学比较，评估NBI模式下鼻咽癌与非癌变黏膜微血管的形态学特点。结果 NBI模式下鼻咽黏膜血管分为黏膜下血管（submucosal vessels, SV）、树枝状血管（branching vessels, BV）以及上皮内乳头状毛细血管袢（intraepithelial papillary capillary loop, IPCL）3类。黏膜下层血管有2种形式，即正常型和扩张型；树枝状血管有3种形式，即正常型、僵直扩张型及弯曲扩张型；上皮内乳头状毛细血管袢有3种形式，即密集点状扩张型、疏松点状扩张型及迂曲扩张型。各组黏膜微血管形态均有所不同。在本组资料中NBI模式对鼻咽癌诊断的阳性预测值为80.9%，其中平坦组为37.5%，隆起组为95.7%，两者差异有统计学意义（P<0.05）。结论 窄带成像技术下鼻咽癌黏膜微血管形态学变化具有特异性，提高对上述血管形态变化的认识可为鼻咽癌的早期诊断提供可靠的依据。

Abstract:

Objective To evaluate mucosal microvascular morphological changes in nasopharyngeal carcinoma (NPC) under narrow band imaging (NBI). Methods From Dec. 2009 and Sept. 2010, a total of 94 patients received biopsy of nasopharyngeal lesions due to the existence of “suspected cancer” under NBI while they were examined with electronic nasopharyngolaryngoscope quipped with white light mode and NBI mode. According to the lesion’s morphology, all the cases were divided into flat lesion group or elevated lesion group. The positive predictive values of the diagnosis of NPC in the NBI mode were separately calculated in the two groups and compared statistically. The morphological characteristics of mucosal superficial microvessels were evaluated. Results Under NBI, three types of vessels were demonstrated in nasopharyngeal mucosa, including submucosal vessels, branching vessels, and intraepithelial papillary capillary loops. The submucosal vessels demonstrated as normal form and expanded form, while branching vessels demonstrated as normal, rigid expanded and winding expanded. Intraepithelial papillary capillary loops had three forms: dense dotted expanded, sparse dotted expanded, and winding expanded. Their morphology was quite different. The total positive predictive value of the diagnosis of NPC in the NBI model was 80.9%, which was 37.5% in flat lesion group and 95.7% in elevated lesion group. The difference of positive predictive values between the two groups was statistically significant (P<0.05). Conclusion Under NBI, the morphology of mucosal microvessels of NPC was characteristic. The recognition of these vessels could be helpful for the early diagnosis of NPC.