Grüber A C, de Barros S G, Pütten A C, Gigante L, Coelho N, Sekine S, Prolla J C
Grupo de Estudos e Pesquisa em Câncer do Esôfago (GEPECE) do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil.
Arq Gastroenterol. 1998 Oct-Dec;35(4):258-63.
Cancer of the esophagus becomes symptomatic at an advanced phase with a late diagnosis, when the tumor is already incurable. Early diagnosis has been shown to improve the survival rates. Conventional esophagoscopy is largely available but its sensitivity to detect early cancer or precancerous lesions remains controversial. In this study we tested the sensitivity of conventional esophagoscopy to identify suspicious areas and compared to histopathology of endoscopic biopsies to detect dysplasia and chronic esophagitis in a population at risk for cancer in southern Brazil. Adult males scheduled to have outpatient endoscopy were examined by two experienced endoscopists and any small (< 5 mm) plaque, nodule, erosion, hyperemia and or friable areas of the mucosa were biopsied and looked for the presence of early cancer or precancerous lesions. Normal appearing mucosa at the middle third of the esophagus was also biopsied and results compared for sensitivity, specificity, positive and negative predictive value. Of the 89 individuals with satisfactory biopsies, 3 had dysplasias, 29 moderate or severe chronic esophagitis and 57 normal findings at the histopathological study. We found no early cancer. We found two large, vegetating lesions confirmed to be advanced squamous cell carcinoma but they were excluded from analysis. To detect dysplasia or moderate/severe chronic esophagitis conventional esophagoscopy had a sensitivity of 40.6%, specificity of 78.9%, positive predictive value of 52% and negative predictive value of 70.3.
In this study, conventional esophagoscopy had a low sensitivity to detect dysplasias and/or chronic esophagitis and techniques to improve endoscopic identification of these lesions in individuals at risk for cancer are much needed.
食管癌在晚期出现症状且诊断较晚，此时肿瘤已无法治愈。早期诊断已被证明可提高生存率。传统食管镜检查广泛可用，但其检测早期癌症或癌前病变的敏感性仍存在争议。在本研究中，我们测试了传统食管镜检查识别可疑区域的敏感性，并与内镜活检的组织病理学结果进行比较，以检测巴西南部癌症高危人群中的发育异常和慢性食管炎。计划进行门诊内镜检查的成年男性由两名经验丰富的内镜医师进行检查，对任何小的（<5mm）斑块、结节、糜烂、充血和/或黏膜易碎区域进行活检，以寻找早期癌症或癌前病变的存在。食管中三分之一外观正常的黏膜也进行了活检，并比较了结果的敏感性、特异性、阳性和阴性预测值。在89例活检结果满意的个体中，组织病理学研究发现3例发育异常、29例中度或重度慢性食管炎和57例正常结果。我们未发现早期癌症。我们发现两个大的、有赘生物的病变被确诊为晚期鳞状细胞癌，但它们被排除在分析之外。对于检测发育异常或中度/重度慢性食管炎，传统食管镜检查的敏感性为40.6%，特异性为78.9%，阳性预测值为52%，阴性预测值为70.3。
在本研究中，传统食管镜检查检测发育异常和/或慢性食管炎的敏感性较低，非常需要改进内镜识别癌症高危个体中这些病变的技术。
