放大内镜联合窄带成像与超声内镜判断早期食管癌浸润深度准确性的对比研究

doi:10.3760/cma.j.issn.1673-422X.2019.01.005

国际肿瘤学杂志 ›› 2019, Vol. 46 ›› Issue (1): 22-26.doi: 10.3760/cma.j.issn.1673-422X.2019.01.005

放大内镜联合窄带成像与超声内镜判断早期食管癌浸润深度准确性的对比研究

吴大鹏,孙仁虎,李杨,韩树堂,肖君

南京中医药大学附属医院（江苏省中医院）消化内镜中心210029

收稿日期:2018-09-06 出版日期:2019-01-08 发布日期:2019-04-03
通讯作者: 肖君 E-mail:cutujun@aliyun.com
基金资助:
江苏省“333工程”培养资金（BRA2017551）

Comparison of magnifying endoscopy combined with narrowband imaging and endoscopic ultrasonography for assessment of the invasion depth of early esophageal cancer

Wu Dapeng, Sun Renhu, Li Yang, Han Shutang, Xiao Jun

Gastroenterology Endoscopy Center, Affiliated Hospital of Nanjing Medical University of Traditional Chinese Medicine (Jiangsu Provincial Hospital of Traditional Chinese Medicine), Nanjing 210029, China

Received:2018-09-06 Online:2019-01-08 Published:2019-04-03
Contact: Xiao Jun E-mail:cutujun@aliyun.com
Supported by:
Jiangsu Province “333 Project” Training Fund (BRA2017551)

摘要/Abstract

摘要： 目的评价放大内镜联合窄带成像（ME-NBI）与超声内镜（EUS）在判断早期食管癌浸润深度方面的临床价值。方法收集2017年1月至2018年5月江苏省中医院胃镜+病理诊断的早期食管癌患者68例，术前先后行ME-NBI和EUS分别判断病变浸润深度，参照术后病理，分别计算两者的准确性，并通过配对四格表χ2检验（McNemar检验）及Kappa检验进行比较。结果术后病理示病灶局限于黏膜层至黏膜下层浅层（m-sm1层）病例57例，突破黏膜下层浅层（sm2-sm3）11例。ME-NBI和EUS对病变术前的评估结果分别与术后病理对照，MENBI与术后病理中度一致（McNemar检验P=0.508；Kappa=0.560，P<0.001），EUS与病理一致性不佳（McNemar检验P=0.019；Kappa=0.266，P=0.015）。ME-NBI和EUS对于早期食管癌浸润深度诊断的总准确率分别为86.8%（59/68）和72.1%（49/68），差异有统计学意义（McNemar检验P=0.015；Kappa=0.258，P=0.026）。结论 ME-NBI与EUS有助于早期食管癌浸润层次的判断，前者准确性更高，对患者手术方案的制定有较高的价值。

关键词: 食管肿瘤, 腔内超声检查, 肿瘤侵润, 放大内镜联合窄带成像

Abstract: Objective To investigate the clinical utility of magnifying endoscopy combined with narrowband imaging (ME-NBI) and endoscopic ultrasonography (EUS) in predicting the depth of early esophageal cancer. Methods Sixtyeight patients with early esophageal cancer after gastroscopic and pathological diagnosis were enrolled in Jiangsu Provincal Hospital of Traditional Chinese Medicine from January 2017 to May 2018, ME-NBI and EUS were performed preoperatively to determine the depth of lesion infiltration respectively, the accuracies of the two methods were calculated by referring to the postoperative pathology, and the McNemar test and Kappa test were used for comparison. Results The lesion confined to shallow mucosa and submucosa superficial layer was confirmed in 57 patients by postoperative pathology, submucosa superficial below in 11 patients. Compared with that of histology, the ability of assessment of the invasion depth was moderately consistent with MENBI (McNemar test P=0.508; Kappa=0.560, P＜0.001), not with EUS (McNemar test P=0.019; Kappa=0.266, P=0.015). The accuracy for assessing invasion depth of early esophageal cancer was 86.8% (59/68) by MENBI, 72.1% (49/68) by EUS, respectively, with statistically significant difference (McNemar test P=0.015; Kappa=0.258, P=0.026). Conclusion ME-NBI and EUS can help to determine the infiltration level of early esophageal cancer. The accuracy of MENBI is higher, which is of high value for the formulation of surgical plans for patients.

Key words: Esophageal neoplasms, Endosonography, Neoplasm invasiveness, Magnifying endoscopy with narrow-band imaging

吴大鹏,孙仁虎,李杨,韩树堂,肖君. 放大内镜联合窄带成像与超声内镜判断早期食管癌浸润深度准确性的对比研究[J]. 国际肿瘤学杂志, 2019, 46(1): 22-26.

Wu Dapeng, Sun Renhu, Li Yang, Han Shutang, Xiao Jun. Comparison of magnifying endoscopy combined with narrowband imaging and endoscopic ultrasonography for assessment of the invasion depth of early esophageal cancer[J]. Journal of International Oncology, 2019, 46(1): 22-26.

参考文献

［1］ Min YW, Lee H, Song BG, et al. Comparison of endoscopic submucosal dissection and surgery for superficial esophageal squamous cell carcinoma: a propensity scorematched analysis［J］. Gastrointest Endosc, 2018, 88(4): 624-633. DOI: 10.1016/j.gie.2018.04.2360. ［2］ Urabe Y, Hiyama T, Tanaka S, et al. Advantages of endoscopic submucosal dissection versus endoscopic oblique aspiration mucosecomy for superficial esophageal tumors［J］. J Gastroenterol Hepatol, 2011, 26(2): 275-280. DOI: 10.1111/j.14401746.2010.06503.x. ［3］ Takubo K, Aida J, Sawabe M, et al. Early squamous cell carcinoma of the oesophagus: the Japanese viewpoint［J］. Histopathology, 2007, 51(6): 733-742. DOI: 10.1111/j.1365-2559.2007.02766.x. ［4］周平红,蔡明琰, 姚礼庆. 消化道黏膜病变内镜黏膜下剥离术的专家共识意见［J］. 诊断学理论与实践, 2012, 11(5): 531-535. DOI: 10.3969/j.issn.1671-2870.2012.05.025. ［5］鹿博, 吴明波, 周甜, 等. 超声内镜联合自体荧光内镜在早期食管癌诊断中的价值［J］. 现代医学, 2016, 44(8): 1053-1055. DOI: 10.3969/j.issn.1671-7562.2016.08.003. ［6］ Murata Y, Napoleon B, Odegaard S. Highfrequency endoscopic ultrasonography in the evaluation of superficial esophageal cancer［J］. Endoscopy, 2003, 35(5): 429-435, 436. DOI: 10.1055/s-2003-38774. ［7］ Participants in the Paris workshop. The Paris endoscopic classification of superficial neoplastic lesions:esphagus［J］. GastrointestEndosc, 2003, 58(6 Suppl): S3-S43. ［8］ Kim SJ, Kim GH, Lee MW, et al. Newmagnifyingendoscopic classificationb for superficialesophagealsquamous cell carcinoma［J］. World J Gastroenterol, 2017, 23(24): 44164421. DOI: 10.3748/wjg.v23.i24.4416. ［9］王金林, 陈倩, 吴小力, 等. 超声内镜在食管癌术前分期中的应用价值及存在的问题［J］. 世界华人消化杂志, 2017, 25(5): 438-442. DOI: 10.11569/wcjd.v25.i5.438. ［10］杨凡, 万海英, 单咏梅, 等. 应用Kappa检验对乙型肝炎病毒血清标志物和丙型肝炎病毒抗体检测方法的评估［J］. 中华实验和临床感染病杂志(电子版), 2010, 4(1): 52-55. DOI: 10.3969/j.issn.1674-1358.2010.01.011. ［11］ Moon JY, Kim GH, Kim JH, et al. Clinicopathologic factors predicting lymph node metastasis in superficial esophageal squamous cell carcinoma［J］. Scand J Gastroenterol, 2014, 49(5): 589-594. DOI: 10.3109/00365521.2013.838604. ［12］ Kuwano H, Nishimura Y, Oyama T, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society［J］. Esophagus, 2015, 12: 1-30. DOI: 10.1007/s10388-014-0465-1. ［13］ Goda K, Tajiri H, Ikegami M, et al. Magnifying endoscopy with narrow band imaging for predicting the invasion depth of superficial esophageal squamous cell carcinoma［J］. Dis Esophagus, 2009, 22(5): 453-460. DOI: 10.1111/j.1442-2050.2009.00942.x. ［14］ Oyama T, Inoue H, Arima M, et al. Prediction of the invasion depth of superficial squamous cell carcinoma based on microvessel morphology: magnifying endoscopic classification of the Japan Esophageal Society［J］. Esophagus, 2017, 14(2): 105112. DOI: 10.1007/s1038801605277. ［15］ Sato H, Inoue H, Ikeda H, et al. Utlity of intrapapillary capillary loops seen on magnifying narrowband imaging in estimating invasive depth of esophageal squamous cell carcinoma［J］. Endoscopy, 2015, 47(2): 122128. DOI: 10.1055/s00341390858. ［16］ Santi EG, Inoue H, Ikeda H, et al. Microvascular caliber changes in intramucosal and submucosally invasive esophageal cancer［J］. Endoscopy, 2013, 45(7): 585-588. DOI: 10.1055/s-0033-1344228. ［17］ Davee T, Ajani JA, Lee JH. Is endoscopic ultrasound examination necessary in the management of esophageal cancer?［J］. World J Gastroenterol, 2017, 23(5): 751-762. DOI: 10.3748/wjg.v23.i5.751. ［18］ Esaki M, Matsumoto T, Moriyama T, et al. Probe EUS for the diagnosis of invasion depth in superficial esophageal cancer: a comparison between a jellyfilled method and a waterfilled balloon method［J］. Gastrointest Endosc, 2006, 63(3): 389-395. DOI: 10.1016/j.gie.2005.10.027. ［19］张月明, 程贵余, 贺舜, 等. 联合应用超声内镜与超声微探头在早期食管癌术前分期中的作用［J］. 中华消化内镜杂志, 2008, 25(3): 138-141. DOI: 10.3760/cma.j.issn.1007-5232.2008.03.008. ［20］ Rampado S, Bocus P, Battaglia G, et al. Endoscopic ultrasound: accuracy in staging superficial carcinomas of the esophagus［J］. Ann Thorac Surg, 2008, 85(1): 251-256. DOI: 10.1016/j.athoracsur.2007.08.021. ［21］ Chemaly M, Scalone O, Durivage G, et al. Miniprobe EUS in the pretherapeutic assessment of early esophageal neoplasia［J］. Endoscopy, 2008, 40(1): 2-6. DOI: 10.1055/s-2007-966958. ［22］ Davee T, Ajani JA, Lee JH. Is endoscopic ultrasound examination necessary in the management of esophageal cancer?［J］. World J Gastroenterol, 2017, 23(5): 751-762. DOI: 10.3748/wjg.v23.i5.751.

[1]	杨蜜, 别俊, 张加勇, 邓佳秀, 唐组阁, 卢俊. 局部晚期可切除食管癌新辅助治疗疗效及预后分析[J]. 国际肿瘤学杂志, 2024, 51(6): 332-337.
[2]	刘静, 刘芹, 黄梅. 基于SMOTE算法的食管癌放化疗患者肺部感染的预后模型构建[J]. 国际肿瘤学杂志, 2024, 51(5): 267-273.
[3]	万芳, 杨钢, 李睿, 万启晶. 食管癌患者血清miR-497、miR-383水平及临床意义[J]. 国际肿瘤学杂志, 2024, 51(4): 204-209.
[4]	中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放射治疗专业委员会. 中国食管癌放射治疗指南（2023年版）[J]. 国际肿瘤学杂志, 2024, 51(1): 1-20.
[5]	高新雨, 李振江, 孙洪福, 韩丹, 赵倩, 刘成新, 黄伟. 基于MR加速器的MR引导放疗在食管癌患者中的临床应用[J]. 国际肿瘤学杂志, 2024, 51(1): 37-42.
[6]	山东省医学会肺癌食管癌多学科联合委员会. 山东省医学会食管癌多学科规范化诊疗指南（2023年版）[J]. 国际肿瘤学杂志, 2023, 50(7): 385-397.
[7]	冀世玉, 张明鑫, 谢华红, 白渊, 王彤. 不同支架治疗晚期食管癌患者的疗效观察[J]. 国际肿瘤学杂志, 2023, 50(2): 76-81.
[8]	巩合义, 伊艳, 张健, 李宝生. 局部晚期可手术食管癌经新辅助放化疗达临床完全缓解后的处理策略[J]. 国际肿瘤学杂志, 2023, 50(12): 745-750.
[9]	赵建昊, 段衍超. 多发性骨髓瘤髓外病变发病机制的研究进展[J]. 国际肿瘤学杂志, 2023, 50(1): 55-59.
[10]	吴浦嫄, 祁亮, 王涛, 史敏科, 孙雨薇, 王立峰, 刘宝瑞, 闫婧, 任伟. 基于高频复发区改良临床靶区的术后放疗在食管鳞状细胞癌中的疗效研究[J]. 国际肿瘤学杂志, 2022, 49(8): 464-472.
[11]	戴李宸, 胡莉钧, 于静萍. 尼妥珠单抗治疗食管鳞状细胞癌的应用进展[J]. 国际肿瘤学杂志, 2022, 49(8): 484-489.
[12]	夏玲玲, 陈永顺, 李彬, 宁婷婷, 张蔡羽天. pN₊食管鳞状细胞癌患者R0切除术后放化疗与化疗的安全性及有效性比较[J]. 国际肿瘤学杂志, 2022, 49(6): 334-339.
[13]	叶倩, 凌志, 刘申香, 路国涛, 殷旭东. 肌肉减少症对老年食管癌患者根治性放疗临床疗效及预后的影响[J]. 国际肿瘤学杂志, 2022, 49(4): 199-205.
[14]	周剑烽, 王铁君. 食管癌的靶向治疗及免疫治疗[J]. 国际肿瘤学杂志, 2022, 49(4): 237-242.
[15]	刘佳, 葛小林, 狄晓珂, 史玉静, 曾玉婷. 喜炎平注射液预防放射性食管炎的疗效分析[J]. 国际肿瘤学杂志, 2022, 49(3): 146-150.

放大内镜联合窄带成像与超声内镜判断早期食管癌浸润深度准确性的对比研究

Comparison of magnifying endoscopy combined with narrowband imaging and endoscopic ultrasonography for assessment of the invasion depth of early esophageal cancer

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价