白光内镜、超声内镜和窄带成像结合放大内镜评估早期贲门癌浸润深度的比较研究

Comparative study of conventional endoscopy,endoscopic ultrasonography and narrow-band imaging combined with magnifying endoscopy in evaluating the depth of invasion of early gastric cardiac cancer

目的评估白光内镜、超声内镜、窄带成像结合放大内镜(ME-NBI)评估早期贲门癌浸润深度的准确度,探讨术前评估早期贲门癌浸润深度的诊断策略。方法回顾性分析2016年1月至2019年6月福建省立医院病理证实为早期贲门癌的135例患者的内镜检查图像,将黏膜内癌和黏膜下浅层(SM1)浸润癌归为黏膜内-SM1癌,以术后病理诊断结果为金标准,与黏膜下深层浸润癌进行比较,评估白光内镜、超声内镜、ME-NBI和三者联合判断早期贲门癌浸润深度的准确度。一致性检验采用Kappa检验,Kappa值<0.2为一致性差,0.2~0.4为一致性一般,>0.4~0.6为一致性中等,>0.6~0.8为一致性较高,>0.8~1.0为接近一致。结果73例早期贲门癌患者资料纳入研究,根据术后病理结果47例为黏膜内-SM1癌,26例为黏膜下深层浸润癌。术前白光内镜、超声内镜、ME-NBI和三者联合判断早期贲门癌浸润深度的准确度分别为79.5%(58/73)、72.6%(53/73)、65.7%(48/73)和87.7%(64/73)。一致性检验结果显示,白光内镜与术后病理诊断结果一致性中等(Kappa值=0.540,P<0.01),超声内镜与术后病理诊断结果一致性一般(Kappa值=0.346,P=0.002),ME-NBI与术后病理诊断结果一致性差(Kappa值=0.175,P=0.108),而三者联合与术后病理诊断结果一致性较高(Kappa值=0.724,P<0.01)。结论与单一检查方法相比,白光内镜、超声内镜和ME-NBI三者联合评估早期贲门癌的浸润深度更准确。

Objective To evaluate the accuracy of white light conventional endoscopy(CE),endoscopic ultrasonography(EUS)and narrow-band imaging with magnifying endoscopy(ME-NBI)in evaluating the invasion depth of early gastric cardiac cancer,and to explore the diagnostic strategy of preoperative evaluation of invasive depth of early gastric cardiac cancer.Methods From January 2016 to June 2019,the endoscopic images of 135 patients with early gastric cardiac cancer confirmed by pathology in Fujian Provincial Hospital were retrospectively analyzed.Intramucosal carcinoma(M)and superficial submucosal invasive carcinoma(SM1)were classified as M-SM1 cancer and compared with deep submucosal invasive cancer.The pathological diagnosis after operation was used as gold standard.The accuracy of CE,EUS,ME-NBI and the combination of them in determining the invasion depth of early gastric cardiac cancer was evaluated.Kappa test was performed for consistency test.Kappa value<0.2 was considered as poor consistency,0.2 to 0.4 as general consistency,more than 0.4 to 0.6 as medium consistency,more than 0.6 to 0.8 as high consistency,and 0.8 to 1.0 as close to full consistency.Results The data of 73 patients with early gastric cardiac cancer were enrolled in this study.According to the pathological results after operation,47 cases were M-SM1 cancer and 26 cases were deep submucosal invasive cancer.The diagnostic accuracy of CE,EUS,ME-NBI and the combination of them before operation were 79.5%(58/73),72.6%(53/73),65.7%(48/73)and 87.7%(64/73),respectively.The results of consistency test indicated that the consistency of CE diagnosis and pathological results after operation was medium(Kappa=0.540,P<0.01),that of EUS and pathological results after operation was general(Kappa=0.346,P=0.002),that of ME-NBI and pathological results after operation was poor(Kappa=0.175,P=0.108),while that of the combination of them and pathological results after operation was high(Kappa=0.724,P<0.01).Conclusions Compared with single examination method,the combination of CE,EUS and ME-NBI is more accurate in evaluating the invasive depth of early gastric cardiac cancer.