邓万银; 林瀛; 林晓露; 王国伟; 郭仙斌; 郑金辉

doi:10.3760/cma.j.cn311367-20200214-00055

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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

中华消化杂志, 2020,40(10) : 680-685. DOI: 10.3760/cma.j.cn311367-20200214-00055

摘要

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。

引用本文: 邓万银, 林瀛, 林晓露, 等. 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 [J] . 中华消化杂志, 2020, 40(10) : 680-685. DOI: 10.3760/cma.j.cn311367-20200214-00055.

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贲门癌是指肿瘤中心位于食管胃交界部上方1 cm至下方2 cm的区域(Siewert分类Ⅱ型)的胃癌^[1]。据国际癌症研究机构统计数据，全球贲门癌总病例中约43%来自中国，且我国部分地区贲门癌发病率逐年升高^[2]。研究表明贲门癌在临床病理特征、流行病学和生物学行为等方面与非贲门癌存在很大差异，且预后较差，术后5年生存率仅为16%～40%^[3,4]。目前，内镜黏膜下剥离术(endoscopic submucosal dissection，ESD)被认为是包括贲门癌在内的早期胃癌安全、有效、可行的标准治疗方法。然而部分接受ESD治疗的患者因无法根治性切除而需行外科手术治疗，黏膜下深浸润是最常见的非治愈性切除原因^[5]，所以在选择治疗方式前须准确预测浸润深度，以便在提高ESD的治愈性切除率的同时避免追加不必要的外科手术。本研究回顾性分析2016年1月至2019年6月福建省立医院诊治的早期贲门癌患者资料，比较白光内镜(conventional endoscopy)、超声内镜(endoscopic ultrasonography)、窄带成像结合放大内镜(magnifying endoscopy combined with narrow band imaging，ME-NBI)和三者联合对早期贲门癌浸润深度判断的准确度，探讨术前评估早期贲门癌浸润深度的诊断策略。

贡献者信息

邓万银

福建省立医院消化内镜中心，福州　350001

林瀛

福建省立医院病理科，福州　350001

林晓露

福建省立医院消化内镜中心，福州　350001

王国伟

福建省立医院消化内镜中心，福州　350001

郭仙斌

福建省立医院消化内镜中心，福州　350001

郑金辉

福建省立医院消化内镜中心，福州　350001

通信作者

郑金辉

福建省立医院消化内镜中心，福州　350001

Email：fjslzhengjinhui@126.com

关键词

早期贲门癌; 浸润深度; 白光内镜; 超声内镜; 窄带成像结合放大内镜;

基金项目

福建省科技厅引导性项目（2017Y0017）

福建省中青年骨干项目（2018-ZQN-11）

作者声明

【引用本文】

中文：邓万银，林瀛，林晓露，等.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[J]．中华消化杂志，2020，40(10)：680-685. DOI：10.3760/cma.j.cn311367-20200214-00055.英文：Deng WY, Lin Y, Lin XL, et al. 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[J]. Chin J Dig, 2020, 40(10): 680-685. DOI: 10.3760/cma.j.cn311367-20200214-00055.

作者贡献声明

邓万银：研究设计、内镜阅片、论文撰写；林瀛：病理学诊断、论文修改；林晓露：数据分析和解释、论文修改；王国伟、郭仙斌：数据整理、统计学分析；郑金辉：研究指导、内镜阅片、经费支持

利益冲突

所有作者均声明不存在利益冲突

历史

出版日期：2020-10-15

收稿日期：2020-02-14

本文编辑

冯缨

Original Article

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

Deng Wanyin, Lin Ying, Lin Xiaolu, Wang Guowei, Guo Xianbin, Zheng Jinhui

Published 2020-10-15

Cite as Chin J Dig, 2020, 40(10): 680-685. DOI: 10.3760/cma.j.cn311367-20200214-00055

Abstract

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.

Key words:

Early gastric cardiac cancer; Invasive depth; Conventional endoscopy; Endoscopic ultrasonography; Magnifying endoscopy combined with narrow band imaging

Contributor Information

Deng Wanyin