摘要
Background The detection rate of narrow-band imaging(NBI)for superficial esophageal squamous cell carcinoma(SESCC),including high-grade intraepithelial neoplasia,is significantly higher than that of white-light endoscopy.However,there are SESCCs that are undetectable by NBI but detectable by Lugol chromoendoscopy(LCE)and the characteristics of these SESCCs are still unknown.Thus,this study aimed to clarify the characteristics of SESCC that are undetectable using NBI.Methods Patients with current SCC or a history of SCC in the head and neck or in the esophagus were enrolled.The inspection of the esophagus was initiated by NBI,followed by LCE.Biopsies were taken of all suspected SESCC lesions during NBI observation and Lugol-voiding lesions(LVLs)that were irregularly shaped and>5mmand/or pink in color during LCE observation.The characteristics of SESCC that were undetectable with NBI were statistically analysed.Results Overall,147 lesions in 105 cases were histologically diagnosed as SESCC.Twenty in 15 cases were NBI-undetectable lesions,all of which were macroscopic flat type(0-IIb).The median sizes of the NBI-undetectable lesions and NBI-detectable lesions were both 15mm(P=0.47).Multivariate analysis revealed independent factors for NBI-undetectable lesions such as numerous irregularly shaped LVLs(odds ratio[OR]:4.94,95%confidence interval[CI]:1.39–17.5,P<0.05)and anterior wall position(OR:4.99,95%CI:1.58–15.8,P<0.05).Conclusions The detection of SESCCs with NBI is challenging when lesions are morphologically completely flat,in cases with numerous irregularly shaped LVLs,and if located at the anterior wall.
背景:窄带成像内镜(NBI)对包括高级别上皮内瘤变在内的浅表性食管鳞状细胞癌(SESCC)的检出率明显高于白光内镜。然而,一些SESCC不能被NBI检测到,却可通过卢戈液染色内镜(LCE)检测到;目前这些SESCC的特征尚不清楚。因此,本研究旨在阐明NBI无法检测到的SESCC的特征。方法:本研究纳入患有头颈或食管SCC或者有头颈或食管SCC病史的患者。首先使用NBI进行食管检查,然后使用LCE检查。使用NBI检查过程中对所有可疑的SESCC病灶以及使用LCE检查过程中对不规则形状和大于5 mm和/或粉红色的卢戈液染色不着色的病变(LVL)进行活检。对NBI下无法发现的SESCC进行统计分析。结果:在105例患者中,147个病灶病理诊断为SESCC,其中15例患者中的20个病灶在NBI下无法检测到;这些病灶的形态均为肉眼观察下的扁平型(0-IIb)。NBI无法检测到的和NBI检测到的病灶大小的中值均为15 mm(P=0.47)。多因素分析揭示了NBI下无法检测到的病灶的独立因素,如大量不规则形状LVL(比值比[OR]:4.94,95%置信区间[CI]:1.39–17.5,P<0.05)和病灶位于食管前壁(OR:4.99,95%CI:1.58–15.8,P<0.05)。结论:当病灶形态完全扁平、内镜下观察到许多不规则形状的LVL或者病灶位于食管前壁时,单独使用NBI检测SESCC具有挑战性。
