食管早期癌及上皮内瘤变内镜分型与病理的关系

Relationship between endoscopic classification and pathology in early esophageal carcinoma and intraepithelial neoplasia

目的通过普通白光内镜及窄带成像放大内镜(narrow-band imaging combined with magnifying endoscopy NBI-ME)观察早期食道癌及癌前病变的内镜分型,并探讨其与病理的关系。方法回顾性分析2011年3月至2014年7月行内镜下黏膜下剥离术治疗的早期食管癌和癌前病变患者的内镜分型及病理结果。结果 152例患者157处病灶纳入研究,其中上皮内乳头状毛细血管襻(intrapapillary capillaryloop,IPCL)为Ⅳ型的有12处,V1型有42处,V2有42处,V3有56处,Vn有5处,内镜下征象为0-Ⅱa型有34处,0-Ⅱb型有95处,0-Ⅱc型有22处,0^-Ⅱa+Ⅱc型有6处。经病理组织证实低级别上皮内瘤变(low-grade intraepithelial neoplasia,LGIN)为58处,高级别上皮内瘤变(high-grade intraepithelial neoplasia,HGIN)为54处,癌为45处。6.4%(10/157)侵犯黏膜下层浅层(sm1),93.6%(147/157)局限于黏膜内。IPCL分型和病理组织的恶性程度具有相关性(列联系数C=0.559 2,P<0.05),LGIN的IPCL以Ⅳ及V1型为主LGIN以IPCL为Ⅳ及V1型为主,HGIN以V2及V3型为主,癌以V3及Vn为主,白光内镜下分型和病理的恶性程度具有相关性(列联系数C=0.496 8,P<0.001),癌主要以0-Ⅱa型为主,HGIN及LGIN中以O-Ⅱb型为主。结论通过白光内镜及NBI-ME观察发现,白光内镜分型和病理具有相关性,癌主要以0-Ⅱa型为主,HGIN及LGIN中以O-Ⅱb型为主;IPCL分型也和病理组织的恶性程度具有相关性,LGIN的IPCL以Ⅳ及V1型为主,HGIN以V2及V3型为主,癌以V3及Vn为主,因此通过对5种食管黏膜IPCL的形态观察及内镜下分型可以推测病理组织学诊断,提高镜下对国人的早期食管癌及癌前病变诊断的准确率,以指导正确的治疗方法及镜下随诊。

Objective To observe endoscopic classification of early esophageal cancer and precancerous lesions by ordinary white light endoscopy and narrow-band imaging combined with magnifying endoscopy（NBI-ME）,and evaluate the relationship between endoscopic classification and pathology.Methods Retrospective analysis of endoscopic classification and pathology was performed in patients with early esophageal cancer and precancerous lesions,who underwent endoscopic submucosal dissection（ESD） from March 2011 to June 2014.Results A total of 157 lesions from 152 subjects with early esophageal cancer and precancerous lesions were collected.Among them,12 Ⅳ type intrapapillary capillary loop（IPCL） patterns,42V1 type IPCL patterns,42 V2 type IPCL patterns,56 V3 type IPCL patterns,and 5 Vn type IPCL patterns were detected by NBI-ME.There were 34 cases in 0-Ⅱa,95 cases in 0-Ⅱb,22 cases in 0-Ⅱc,and 6 cases in 0-Ⅱ a ＋ Ⅱ c,which were detected by white light endoscopy.Of the 157 lesions,58 of low-grade intraepithelial neoplasia（LGIN）,54 of high-grade intraepithelial neoplasia（HGIN）,and 45 of carcinoma（Ca） were found.There were 6.4%（10 /157） lesions invading the submucosa（sm1）,and 93.6%（147 /157） lesions confined in the mucosa.The IPCL types were associated with the malignant degree of pathological tissue（C = 0.559 2,P 〈 0.05）.The IPCL patterns were mainly IV and V1 in LGIN,mainly V2 and V3 in HGIN,and mainly V3 and Vn in Ca.The endoscopic classification based on white light endoscopy was associated with the malignant degree of pathological tissue（C = 0.496 8,P 〈 0.001）.The endoscopic classification of Ca was mainly 0-Ⅱ a,while HGIN and LGIN were mainly 0-Ⅱ b.Conclusion The endoscopic classification based on white light endoscopy is associated with the pathological tissue,that is,Ca is mainly 0-Ⅱa,and HGIN and LGIN are mainly 0-Ⅱb.The IPCL types are also associated with the pathological tissue.The IPCL patterns of LGIN,HGIN and Ca were mainly Ⅳ and V1,mainly V2 and V3,and mainly V3 and Vn,respectively.The IPCL pattern observation and endoscopic classification of the esophageal lesions can roughly predict histopathological diagnosis,and improve the diagnosis accurate rate of esophageal cancer and precancerous lesions,so as to direct correct treatment and follow-up by endoscopy in our country.