| Objective: By observing the different microstructure and microvascular morphology of patients under magnification endoscopy and corresponding to postoperative pathological diagnosis,the relationship between the microstructure and microvascular morphology and early gastric cancer,histological type and depth of invasion was analyzed,so as to improve the accuracy of preoperative evaluation and the cure rate of early gastric cancer.Methods: A total of 165 patients who received endoscopic treatment after magnification endoscopy in the Second Hospital of Hebei Medical University from January 2019 to December 2020 were selected.The surface structures observed by magnification endoscopy combined with narrow-band imaging were divided into round,strip,nipple,destruction,and disappearance,and the microvascular morphology was divided into regular,ring,grid,spiral,and disappearance,and the presence of dilated vessels was observed.Pathological diagnosis was identified as the gold standard.Retrospective analysis was conducted to evaluate the diagnostic value of magnification endoscopy for early gastric cancer by analyzing the different microstructures and microvascular morphology and the relationships between cancer and non-cancer,differentiated gastric cancer and undifferentiated gastric cancer,intramucosal cancer and submucosal cancer.Results:1.In this study,171 lesions were included in 165 patients,with a male to female ratio of 4.16:1 and an average age of 62.3±8.7 years.Lesions were mainly distributed in the upper 1/3 of the stomach(55.0%),including 41.5%in the cardia and 13.5% in the fundus of the stomach,followed by the middle1/3 of the stomach(16.9%)and the lower 1/3 of the stomach(28.1%).2.Under the observation of ME-NBI,different surface structure and microvascular morphology were significantly correlated with the degree of lesion(P<0.001).The changes of surface structure and microvascular morphology at the same time were significantly different between cancerous lesions and non-cancerous lesions(P<0.001).3.After ME-NBI observation,there were significant differences in surface structure and microvascular morphology among different differentiation types(P<0.05).4.Under ME-NBI observation,there are significant differences in the surface structure between different infiltration depths(P<0.05),there is no significant difference in the microvascular structure(P=0.15),and there is a significant difference in the existence of dilated blood vessels in intramucosal cancer and submucosal cancer(P<0.001),the sensitivity of the diagnosis of submucosal invasive carcinoma by the presence of dilated blood vessels was54.5%,specificity was 84.1%,accuracy was 75.7%,positive predictive value was 58.1%,and negative predictive value was 82.1%.Conclusion:1.In endoscopic examination,high attention should be paid to middle-aged and elderly men,and the cardia should be carefully observed to avoid missed diagnosis.2.If the surface structure is nipple,destruction and disappearance or the microvascular morphology is ring,network,spiral and disappearance,we should be alert to the lesions of early gastric cancer.When both of them change,it should be highly suspected that the lesion is early gastric cancer.3.Compared with undifferentiated gastric cancer,differentiated gastric cancer is more likely to present as reticular microvascular morphology.Compared with differentiated gastric cancer,the surface structure of undifferentiated gastric cancer is more likely to show the destructive type and the morphology of microvessels is more likely to be spiral,but it still needs to expand the samples of undifferentiated gastric cancer for further exploration.4.The surface structure of intramucosal cancer is more papillary than that of submucosal cancers,and the presence of dilated blood vessels is helpful for the diagnosis of submucosal invasive cancer. |
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