EUS及ME-NBI对早期食管癌浸润深度诊断准确性的临床分析

Accuracy of EUS and ME-NBI for Evaluating the Invasion Depth of Early Esophageal Cancer

目的探讨超声内镜(EUS)及放大内镜-窄带成像技术(ME-NBI)对早期食管癌浸润深度的诊断准确性。方法回顾性纳入2013年3月至2017年10月术前诊断为早期食管癌并行内镜下治疗的患者,比较术前EUS和ME-NBI对病变浸润深度的判断与术后病理浸润深度的一致率。结果本研究共纳入333例患者(392处病灶),其中轻中度不典型增生83处,重度不典型增生72处,鳞状细胞癌235处,腺鳞癌2处。308处病灶仅经过EUS检查,7处病灶仅经过ME-NBI检查,77处病灶同时经过两种方式检查。385处病灶经EUS评估,对病变浸润深度的诊断准确率为43.9%(169/385),与病理诊断一致性差(Kappa=0.1)。对局限于黏膜层的病变EUS准确率为40.8%(139/341),黏膜下层病变准确率为68.2%(30/44)(P=0.001)。84处病灶经ME-NBI评估,对病变浸润深度的诊断准确率为72.6%(61/84),与病理诊断具有中等一致性(Kappa=0.4),对局限于黏膜层的病变其准确率为91.0%(71/78),对于达黏膜下层的病变其准确率为16.7%(1/6)。同时行EUS及ME-NBI检查的77处病灶,EUS诊断准确率为42.9%(33/77),ME-NBI对浸润深度的诊断准确率为84.3%(67/77)(P=0.001)。结论ME-NBI对早期食管癌浸润深度的评估优于EUS。

Objective To assess the accuracy of endoscopic ultrasound （EUS） and magnifying endoscopy with narrow-band imaging （ME-NBI） in evaluating the invasion depth of early esophageal carcinoma. Methods Patients who underwent endoscopic resection for early esophageal cancer from March 2013 to October 2017 were enrolled. The EUS and ME-NBI results were compared with the pathology results. Results A total of 392 lesions from 333 patients were assessed, including 83 mild and moderate dysplasia, 72 severe dysplasia, 235 squamous cell carcinoma, and 2 adenosquamous carcinoma. About 308 lesions were given EUS only, 7 had ME-NBI only, 77 underwent both EUS and ME-NBI. EUS resulted in a 43.9% accuracy for the 385 lesions, with poor consistency （Kappa=0.1） with the pathology results. But higher accuracy （68.2%） was found for lesions infiltrating into the submucosa of the lesions, compared with 40.5% for lesions contained within the mucosa （P=0.001）. ME-NBI resulted in a 72.6% accuracy for the 84 lesions, with a medium consistency （Kappa=0.4）. The accuracy for lesions contained within the mucosa was 91.0%, compared with 16.7% for lesions infilrtrating into the submucosa （P=0.001）. EUS and ME-NBI for the 77 lesions demonstrated an accuracy of 42.9% for the EUS and 84.3% for the ME-NBI （P=0.001）. Conclusion ME-NBI has higher accuracy than EUS in evaluating the invasion depth of early esophageal carcinoma.