Bergman Jacques J G H M
Oesophageal Research Team, Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Best Pract Res Clin Gastroenterol. 2006;20(5):843-66. doi: 10.1016/j.bpg.2006.04.010.
The endoscopic evaluation of patients with oesophageal adenocarcinoma does not only serve the purpose of diagnosing the lesion and obtaining biopsies for histological evaluation: a systematic description of advanced lesions is also required to guide further therapeutic decisions. New endoscopic imaging modalities hold the promise of better endoscopic detection of early cancer and its precursor lesions in Barrett's oesophagus. Video-autofluorescence and narrow band imaging are the most promising techniques in this respect. The former may be used as a 'red flag' technique, identifying lesions that remain occult with white light endoscopy; the latter may be used as a targeted imaging technique, allowing for detailed inspection of the mucosal and vascular patterns that may help to distinguish early neoplasia from non-dysplastic tissue. Currently, prototypes are under investigation that combine high-resolution endoscopy, narrow band imaging and video-autofluorescence in one endoscopy system. Endoscopic ultrasonography (EUS) is superior to any other imaging modality in the assessment of local tumour infiltration of oesophageal adenocarcinoma and locoregional lymph nodes status. EUS allows for the identification of patients with advanced disease who are unlikely to benefit from attempts at curative surgery and in whom a conservative palliative treatment is indicated. EUS may also play a role in the selection of patients for local endoscopic treatment of early oesophageal cancer. EUS guided fine needle aspiration (EUS-FNA) of locoregional lymph nodes is safe with a high sensitivity and an impeccable specificity for assessment of malignant involvement. The indications for EUS-FNA of lymph nodes, however, depend on local treatment protocols: caeliac nodes (M1a) and lymph nodes located at or above the subcarinal area are the most widely used indications. In addition, it may be important if the choice for specific treatment protocols (e.g. neoadjuvant chemoradiotherapy) depends on lymph node status.
对食管腺癌患者进行内镜评估，其目的不仅在于诊断病变并获取活检组织进行组织学评估：还需要对进展期病变进行系统描述，以指导进一步的治疗决策。新型内镜成像模式有望更好地在内镜下检测巴雷特食管中的早期癌症及其前驱病变。在这方面，视频自体荧光成像和窄带成像技术最具前景。前者可用作一种“警示”技术，识别白光内镜检查难以发现的病变；后者可用作靶向成像技术，详细检查黏膜和血管形态，有助于区分早期肿瘤与非发育异常组织。目前，正在研究将高分辨率内镜、窄带成像和视频自体荧光成像整合于一个内镜系统的原型。内镜超声检查（EUS）在评估食管腺癌的局部肿瘤浸润及区域淋巴结状况方面优于其他任何成像模式。EUS能够识别那些不太可能从根治性手术中获益、而适合采取保守姑息治疗的进展期疾病患者。EUS在早期食管癌局部内镜治疗的患者选择中也可发挥作用。EUS引导下对区域淋巴结进行细针穿刺抽吸活检（EUS-FNA）安全可靠，对评估恶性浸润具有高敏感性和无可挑剔的特异性。然而，EUS-FNA对淋巴结的检查指征取决于当地的治疗方案：腹腔淋巴结（M1a）以及隆突下区域或其上方的淋巴结是最常用的检查指征。此外，如果特定治疗方案（如新辅助放化疗）的选择取决于淋巴结状况，这一点可能很重要。
