BACKGROUND Lugol chromoendoscopy(LCE)has served as a standard screening technique in high-risk patients with esophageal cancer.Nevertheless,LCE is not suitable for general population screening given its side effects.L...BACKGROUND Lugol chromoendoscopy(LCE)has served as a standard screening technique in high-risk patients with esophageal cancer.Nevertheless,LCE is not suitable for general population screening given its side effects.Linked color imaging(LCI)is a novel image-enhanced endoscopic technique that can distinguish subtle differences in mucosal color.AIM To compare the diagnostic performance of LCI with LCE in detecting esophageal squamous cell cancer and precancerous lesions and to evaluate whether LCE can be replaced by LCI in detecting esophageal neoplastic lesions.METHODS In this prospective study,we enrolled 543 patients who underwent white light imaging(WLI),LCI and LCE successively.We compared the sensitivity and specificity of LCI and LCE in the detection of esophageal neoplastic lesions.Clinicopathological features and color analysis of lesions were assessed.RESULTS In total,43 patients(45 neoplastic lesions)were analyzed.Among them,36 patients(38 neoplastic lesions)were diagnosed with LCI,and 39 patients(41 neoplastic lesions)were diagnosed with LCE.The sensitivity of LCI was similar to that of LCE(83.7%vs 90.7%,P=0.520),whereas the specificity of LCI was greater than that of LCE(92.4%vs 87.0%,P=0.007).The LCI procedure time in the esophageal examination was significantly shorter than that of LCE[42(34,50)s vs 160(130,189)s,P<0.001].The color difference between the lesion and surrounding mucosa in LCI was significantly greater than that observed with WLI.However,the color difference in LCI was similar in different pathological types of esophageal squamous cell cancer.CONCLUSION LCI offers greater specificity than LCE in the detection of esophageal squamous cell cancer and precancerous lesions,and LCI represents a promising screening strategy for general populations.展开更多
Objective:To explore the differences in the effect of peroral traction-assisted endoscopic submucosal dissection (ESD) and traditional ESD for the treatment of early gastric cancer and precancerous lesions. Methods:11...Objective:To explore the differences in the effect of peroral traction-assisted endoscopic submucosal dissection (ESD) and traditional ESD for the treatment of early gastric cancer and precancerous lesions. Methods:112 patients with early gastric cancer and precancerous lesions treated in our hospital between May 2013 and May 2016 were collected and divided into control group and observation group according to the random number table (n=56). Observation group of patients received peroral traction-assisted ESD, and the control group of patients only received traditional ESD. The intraoperative dissected lesion diameter, mean operation time and intraoperative blood loss of two groups of patients were recorded, enzyme-linked immunosorbent assay was used to detect serum inflammatory factor levels, and RIA was used to detect serum stress hormone levels. Results:Dissected lesion diameter of observation group was greater than that of control group (P<0.05) while mean operation time and intraoperative blood loss were less than those of control group (P<0.05);1 d after operation, serum inflammatory factors interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-12 (IL-12) and tumor necrosis factor-α(TNF-α) levels of observation group were lower than those of control group (P<0.05), and serum stress hormones cortisol (Cor),β-endorphin (β-EP), epinephrine (E), norepinephrine (NE) and angiotensin II (ATII) levels were lower than those of control group (P<0.05). Conclusions:Peroral traction-assisted ESD can effectively increase the lesion dissection effect and reduce the postoperative inflammatory response and stress response in patients with early gastric cancer and precancerous lesions.展开更多
AIM:To explore the DNA image cytometry (DNA-ICM) technique as a primary screening method for esopha-geal squamous precancerous lesions.METHODS:This study was designed as a population-based screening study.A total of 5...AIM:To explore the DNA image cytometry (DNA-ICM) technique as a primary screening method for esopha-geal squamous precancerous lesions.METHODS:This study was designed as a population-based screening study.A total of 582 local residents aged 40 years-69 years were recruited from Linzhou in Henan and Feicheng in Shandong.However,only 452 subjects had results of liquid-based cytology,DNA-ICM and pathology.The sensitivity and specificity of DNA-ICM were calculated and compared with liquid-based cytology in moderate dysplasia or worse.RESULTS:Sensitivities of DNA-ICM ranging from at least 1 to 4 aneuploid cells were 90.91%,86.36%,79.55% and 77.27%,respectively,which were better than that of liquid-based cytology (75%).Specifici-ties of DNA-ICM were 70.83%,84.07%,92.65% and 96.81%,but the specificity of liquid-based cytology was 91.91%.The sensitivity and specificity of a combination of liquid-based cytology and DNA-ICM were 84.09% and 85.78%,respectively.CONCLUSION:It is possible to use DNA-ICM tech-nique as a primary screening method for esophageal squamous precancerous lesions.展开更多
AIM:To assess the diagnostic value of using magnifying chromoendoscopy combined with immunohisto-chemical staining of proliferating cell nuclear antigen (PCNA)and p53 in the detection of gastric precancerous lesions. ...AIM:To assess the diagnostic value of using magnifying chromoendoscopy combined with immunohisto-chemical staining of proliferating cell nuclear antigen (PCNA)and p53 in the detection of gastric precancerous lesions. METHODS:Ninety-five patients who were treated for abdominal discomfort,abdominal pain,bloating,and acid reflux at our hospital from January 2010 to December 2011 were included in the study.An ordinary gastroscopic procedure was initially performed to select the lesions.All subjects underwent magnifying chromo-endoscopy to observe morphological changes of gastric pits.Biopsies were then taken from each area of interest and sent for pathological examination and detection of PCNA and p53 expression by immunohistochemistry. An immunoreactivity score for each lesion was calcu-lated.Based on immunoreactivity scores,immunohisto-chemical staining was then considered. RESULTS:Compared to intestinal metaplasia,gastric pits were more diverse in size,more irregular in shape, and more disorderly in arrangement in moderate and severe dysplasia.PCNA and p53 expression was sig-nificantly higher in precancerous lesions(intestinal metaplasia and dysplasia)than in chronic gastritis. PCNA expression showed an upward trend in types A-F pits.The number of cases that showed strong PCNA positivity increased significantly with an increase in the severity of lesions.Rank sum test for independent samples showed that p53 expression was significantly higher in types E and F pits than in types A-D pits(H =33.068,P=0.000).Rank sum test for independent samples showed that PCNA expression was significantly higher in types E and F pits than in types A-D pits(H =31.791,P=0.001). CONCLUSION:The presence of types E and F pits,in which p53 and PCNA are highly expressed,is highly sug- gestive of the occurrence of early cancer,and patients developing these changes should be closely followed.展开更多
OBJECTIVE To investigate the natural history of fast developing esopha- geal and cardia precursors. METHODS Repetitive endoscopic screenings were performed among 40-69-year-olds in the high-incidence areas for esophag...OBJECTIVE To investigate the natural history of fast developing esopha- geal and cardia precursors. METHODS Repetitive endoscopic screenings were performed among 40-69-year-olds in the high-incidence areas for esophageal cancer in Shexian. RESULTS The initial diagnosis and the lag-time for 7 subsequently identified severe dysplasia(SD)subjects were as follows:in one subject 13 months after a baseline diagnosis of normal epithelium,in another subject 7 months after a baseline diagnosis of base cell hyperplasia(BCH),in four subjects 3,4,4,and 10.5 months after baseline diagnosis of mild dysplasia (mD),and in one subject 12.5 months after a baseline diagnosis of moder- ate dysplasia(MD).The initial diagnosis and the lag-time for 6 subsequently identified carcinomas in situ or intramucosal carcinoma cases were:in one case 48 months after a baseline diagnosis of mD,in 2 cases 4 and 13 months after baseline diagnoses of MD,and in the other 3 cases 3.5,9,and 17.5 months after baseline diagnoses of SD.The initial diagnosis and lag- time for 3 subsequently identified invasive cancer cases were:in one case 50 months after a baseline diagnosis of MD,in 2 cases 14 and 19 months after baseline diagnoses of SD.In addition,during a 4-year-fol ow-up of 18 subjects after endoscopic mucosa resection,9 of them were found to have developed precursors again at other sites,and also additional findings were obtained for 11 of the 16 dysplasia cases by repetitive biopsy in less than 2 months after the initial endoscopy. CONCLUSION A 5-year screening interval for BCH and mD,and a 3-year interval for MD may be too long for the fast developing precursors.Periodic screenings with shorter intervals should be considered to control the number of interval cases due to fast development,multifocal carcinogenesis,and false negative results inherent in one-time endoscopic biopsy sampling.展开更多
基金Supported by the National Natural Science Foundation of China,No.81270564 and 82100697.
文摘BACKGROUND Lugol chromoendoscopy(LCE)has served as a standard screening technique in high-risk patients with esophageal cancer.Nevertheless,LCE is not suitable for general population screening given its side effects.Linked color imaging(LCI)is a novel image-enhanced endoscopic technique that can distinguish subtle differences in mucosal color.AIM To compare the diagnostic performance of LCI with LCE in detecting esophageal squamous cell cancer and precancerous lesions and to evaluate whether LCE can be replaced by LCI in detecting esophageal neoplastic lesions.METHODS In this prospective study,we enrolled 543 patients who underwent white light imaging(WLI),LCI and LCE successively.We compared the sensitivity and specificity of LCI and LCE in the detection of esophageal neoplastic lesions.Clinicopathological features and color analysis of lesions were assessed.RESULTS In total,43 patients(45 neoplastic lesions)were analyzed.Among them,36 patients(38 neoplastic lesions)were diagnosed with LCI,and 39 patients(41 neoplastic lesions)were diagnosed with LCE.The sensitivity of LCI was similar to that of LCE(83.7%vs 90.7%,P=0.520),whereas the specificity of LCI was greater than that of LCE(92.4%vs 87.0%,P=0.007).The LCI procedure time in the esophageal examination was significantly shorter than that of LCE[42(34,50)s vs 160(130,189)s,P<0.001].The color difference between the lesion and surrounding mucosa in LCI was significantly greater than that observed with WLI.However,the color difference in LCI was similar in different pathological types of esophageal squamous cell cancer.CONCLUSION LCI offers greater specificity than LCE in the detection of esophageal squamous cell cancer and precancerous lesions,and LCI represents a promising screening strategy for general populations.
文摘Objective:To explore the differences in the effect of peroral traction-assisted endoscopic submucosal dissection (ESD) and traditional ESD for the treatment of early gastric cancer and precancerous lesions. Methods:112 patients with early gastric cancer and precancerous lesions treated in our hospital between May 2013 and May 2016 were collected and divided into control group and observation group according to the random number table (n=56). Observation group of patients received peroral traction-assisted ESD, and the control group of patients only received traditional ESD. The intraoperative dissected lesion diameter, mean operation time and intraoperative blood loss of two groups of patients were recorded, enzyme-linked immunosorbent assay was used to detect serum inflammatory factor levels, and RIA was used to detect serum stress hormone levels. Results:Dissected lesion diameter of observation group was greater than that of control group (P<0.05) while mean operation time and intraoperative blood loss were less than those of control group (P<0.05);1 d after operation, serum inflammatory factors interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-12 (IL-12) and tumor necrosis factor-α(TNF-α) levels of observation group were lower than those of control group (P<0.05), and serum stress hormones cortisol (Cor),β-endorphin (β-EP), epinephrine (E), norepinephrine (NE) and angiotensin II (ATII) levels were lower than those of control group (P<0.05). Conclusions:Peroral traction-assisted ESD can effectively increase the lesion dissection effect and reduce the postoperative inflammatory response and stress response in patients with early gastric cancer and precancerous lesions.
基金Supported by Grants from the Ministry of Health of China,No.200902002-8Grants from Cancer Institute/Hospital Chinese Academy of Medical Sciences and Peking Union Medical College,No.2009YF50
文摘AIM:To explore the DNA image cytometry (DNA-ICM) technique as a primary screening method for esopha-geal squamous precancerous lesions.METHODS:This study was designed as a population-based screening study.A total of 582 local residents aged 40 years-69 years were recruited from Linzhou in Henan and Feicheng in Shandong.However,only 452 subjects had results of liquid-based cytology,DNA-ICM and pathology.The sensitivity and specificity of DNA-ICM were calculated and compared with liquid-based cytology in moderate dysplasia or worse.RESULTS:Sensitivities of DNA-ICM ranging from at least 1 to 4 aneuploid cells were 90.91%,86.36%,79.55% and 77.27%,respectively,which were better than that of liquid-based cytology (75%).Specifici-ties of DNA-ICM were 70.83%,84.07%,92.65% and 96.81%,but the specificity of liquid-based cytology was 91.91%.The sensitivity and specificity of a combination of liquid-based cytology and DNA-ICM were 84.09% and 85.78%,respectively.CONCLUSION:It is possible to use DNA-ICM tech-nique as a primary screening method for esophageal squamous precancerous lesions.
基金Supported by Grant from the Medical and Health Research Program of Inner Mongolia Autonomous Region,No.2010069
文摘AIM:To assess the diagnostic value of using magnifying chromoendoscopy combined with immunohisto-chemical staining of proliferating cell nuclear antigen (PCNA)and p53 in the detection of gastric precancerous lesions. METHODS:Ninety-five patients who were treated for abdominal discomfort,abdominal pain,bloating,and acid reflux at our hospital from January 2010 to December 2011 were included in the study.An ordinary gastroscopic procedure was initially performed to select the lesions.All subjects underwent magnifying chromo-endoscopy to observe morphological changes of gastric pits.Biopsies were then taken from each area of interest and sent for pathological examination and detection of PCNA and p53 expression by immunohistochemistry. An immunoreactivity score for each lesion was calcu-lated.Based on immunoreactivity scores,immunohisto-chemical staining was then considered. RESULTS:Compared to intestinal metaplasia,gastric pits were more diverse in size,more irregular in shape, and more disorderly in arrangement in moderate and severe dysplasia.PCNA and p53 expression was sig-nificantly higher in precancerous lesions(intestinal metaplasia and dysplasia)than in chronic gastritis. PCNA expression showed an upward trend in types A-F pits.The number of cases that showed strong PCNA positivity increased significantly with an increase in the severity of lesions.Rank sum test for independent samples showed that p53 expression was significantly higher in types E and F pits than in types A-D pits(H =33.068,P=0.000).Rank sum test for independent samples showed that PCNA expression was significantly higher in types E and F pits than in types A-D pits(H =31.791,P=0.001). CONCLUSION:The presence of types E and F pits,in which p53 and PCNA are highly expressed,is highly sug- gestive of the occurrence of early cancer,and patients developing these changes should be closely followed.
基金This work was partially supported by Grantsfrom the Hebei Provincial Natural ScientificFoundation(No.C2005000797)fromFunds for the Potential y Distinguished Sci-entific Project Construction in Hebei Universi-ties.
文摘OBJECTIVE To investigate the natural history of fast developing esopha- geal and cardia precursors. METHODS Repetitive endoscopic screenings were performed among 40-69-year-olds in the high-incidence areas for esophageal cancer in Shexian. RESULTS The initial diagnosis and the lag-time for 7 subsequently identified severe dysplasia(SD)subjects were as follows:in one subject 13 months after a baseline diagnosis of normal epithelium,in another subject 7 months after a baseline diagnosis of base cell hyperplasia(BCH),in four subjects 3,4,4,and 10.5 months after baseline diagnosis of mild dysplasia (mD),and in one subject 12.5 months after a baseline diagnosis of moder- ate dysplasia(MD).The initial diagnosis and the lag-time for 6 subsequently identified carcinomas in situ or intramucosal carcinoma cases were:in one case 48 months after a baseline diagnosis of mD,in 2 cases 4 and 13 months after baseline diagnoses of MD,and in the other 3 cases 3.5,9,and 17.5 months after baseline diagnoses of SD.The initial diagnosis and lag- time for 3 subsequently identified invasive cancer cases were:in one case 50 months after a baseline diagnosis of MD,in 2 cases 14 and 19 months after baseline diagnoses of SD.In addition,during a 4-year-fol ow-up of 18 subjects after endoscopic mucosa resection,9 of them were found to have developed precursors again at other sites,and also additional findings were obtained for 11 of the 16 dysplasia cases by repetitive biopsy in less than 2 months after the initial endoscopy. CONCLUSION A 5-year screening interval for BCH and mD,and a 3-year interval for MD may be too long for the fast developing precursors.Periodic screenings with shorter intervals should be considered to control the number of interval cases due to fast development,multifocal carcinogenesis,and false negative results inherent in one-time endoscopic biopsy sampling.
