不同内镜方式判断早期食管癌浸润深度准确性的对比研究
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Comparison of different endoscopic methods for infiltration depth of early esophageal cancer
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    摘要:

    目的 评价不同内镜方法在判断早期食管癌浸润深度方面的临床价值。 方法 2013年8月至2016年2月,在四川省人民医院消化内科行白光内镜检查拟诊早期食管癌的患者,依次采用窄带成像(NBI)放大内镜(分别使用IPCL分型和B分型方法)、超声内镜判断浸润深度,随后碘染取活检,其中活检病理提示中-重度异型增生、高级别上皮内瘤变及早期食管癌的患者,以及虽然活检病理提示低级别上皮内瘤变但白光或者NBI内镜高度提示食管癌的患者接受内镜或外科手术切除治疗,最终病理(活检及手术病理的最高诊断)确诊为早期食管癌的患者共54例,针对这部分患者使用Kappa值统计上述不同内镜方式判断早期食管癌浸润深度的准确性。 结果 NBI放大内镜下B分型与最终病理一致性好(Kappa=0.802),白光内镜(Kappa=0.596)和NBI放大内镜下IPCL分型(Kappa=0.601)与最终病理具有中等一致性,超声内镜与最终病理的一致性较差(Kappa=0.132)。在判断早期食管癌M1~M2浸润方面,B分型的准确率最高(86.7%,26/30),其次为白光内镜(76.7%,23/30)和IPCL分型(73.3%,22/30),超声内镜的准确率最低(30.0%,9/30),并且其过度判率最高(70.0%,21/30);在判断早期食管癌M3~SM1浸润方面,B分型的准确率最高(89.5%,17/19),其次为IPCL分型(78.9%,15/19)和白光内镜(73.7%,14/19),超声内镜的准确率最低(42.1%,8/19),并且其过度判率最高(52.6%,10/19)。 结论 白光内镜在判断早期食管癌浸润深度方面仍有较大临床价值;NBI放大内镜下的B分型和IPCL分型较白光内镜更有优势,其中B分型较IPCL分型具有一定的优势,并且对于初学者更简单和易于掌握;超声内镜在判断黏膜及黏膜下各层浸润时的准确性不尽如人意,过度判率高,在单独使用时需谨慎。

    Abstract:

    Objective To compare the clinical value of different endoscopic methods for infiltration depth of early esophageal cancer. Methods Patients with suspected esophageal cancer, examined in Sichuan Provincial People′s Hospital from August 2013 to February 2016 were enrolled to this study. The patients underwent narrow band imaging(NBI) with magnifying endoscopy(including IPCL-type and B-type methods) and endoscopic ultrasonography(EUS) to estimate infiltration depth and then underwent iodine staining and biopsy. All lesions, which included the identified moderate-severe hyperplasia, high-grade intraepithelial neoplasia and early esophageal cancer and those which were diagnosed as possible cancer by white light and NBI with the negative pathological results, were given endoscopic or surgical procedure depending on patients′ choices. A total of 54 cases were diagnosed as early esophageal cancer, with pathological results as the gold standard. The diagnostic accuracy of invasion depth of these patients was compared by the statistic kappa values. Results Type B of NBI was highly consistent with the final pathological results(Kappa=0.802). White light endoscopy and IPCL type had poorer results(Kappa=0.596, Kappa=0.601) compared with the final pathological results. However, EUS had the lowest consistency with the final pathological results(Kappa=0.132). For the mucosal layer(M1-M2) infiltration of the esophageal cancer, type B showed the highest accuracy(86.7%, 26/30), followed by white light endoscopy(76.7%, 23/30) and IPCL type(73.3%, 22/30). And EUS showed the lowest diagnostic accuracy(30.0%, 9/30) and the highest over-diagnostic rate(70.0%,21/30). For the cancer infiltration depth(M3-SM1), type B also showed slightly higher accuracy rate(89.5%, 17/19) than IPCL type (78.9%, 15/19) and white light endoscopy (73.7%, 14/19). And EUS still showed the lowest accuracy rate(42.1%, 8/19) and the highest over-diagnostic rate(52.6%, 10/19). Conclusion White light endoscopy is still valuable for the invation depth of early esophageal cancer. But B type and IPCL-type of NBI are superior to white light endoscopy. B type presents higher accuracy rate than others, and it seems much easier to operate than IPCL-type for beginners. Accuracy rate of EUS is unsatisfactory, and the over-diagnostic rate is much higher than others. Diagnosis with EUS alone is not recommended.

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张志宏.不同内镜方式判断早期食管癌浸润深度准确性的对比研究[J].中华消化内镜杂志,2017,34(1):43-48.

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  • 在线发布日期: 2017-04-10
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