Hizawa Kazuoki, Tamiya Sadafumi, Nakahara Tsukane, Matsumoto Takayuki, Iida Mitsuo
Department of Internal Medicine, Kyushu Central Hospital, Fukuoka, Japan.
Hepatogastroenterology. 2007 Sep;54(78):1725-7.
BACKGROUND/AIMS: Screening endoscopy for upper gastrointestinal cancer has come into wide use in Japan. We aim to clarify the limitation of its endoscopic diagnosis and contribution of histological biopsy on routine endoscopy.
For consecutive 1184 patients (696 men and 488 women, average age of 57 years) undergoing routine esophagogastroduodenoscopy, we prospectively evaluated endoscopic diagnosis with regard to grade of malignancy (definitely cancer, E5; probably cancer, E4; dysplasia/adenoma or indeterminate malignant, E3; probably benign, E2; and definitely benign, E1). Histological grade was defined as H5 (cancer), H4 (probably cancer), H3 (dysplasia/ adenoma or indeterminate malignant), H2 (probably benign), and H1 (definitely benign) in 267 patients undergoing endoscopic forceps biopsy. We analyzed the accuracy of endoscopic and histological biopsy diagnosis.
Incidence of neoplastic lesions including H3, H4, and H5 was 0% in E1 (0/978), 2% in E2 (3/132), 19% in E3 (6/31), 33% in E4 (3/9), and 100% in E5 lesions (34/34). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endoscopic diagnosis for these neoplastic lesions were 94%, 97%, 58%, 99%, and 97%, respectively.
Better awareness of its endoscopic features and appropriate endoscopic biopsy is essential in the diagnosis of upper gastrointestinal cancer on screening endoscopy.
背景/目的：上消化道癌的筛查内镜检查在日本已广泛应用。我们旨在阐明其内镜诊断的局限性以及组织活检在常规内镜检查中的作用。
对于连续1184例行常规食管胃十二指肠镜检查的患者（696名男性和488名女性，平均年龄57岁），我们前瞻性地前瞻性评估了内镜诊断的恶性程度分级（肯定为癌，E5；可能为癌，E4；发育异常/腺瘤或恶性不确定，E3；可能为良性，E2；肯定为良性，E1）。在267例行内镜钳取活检的患者中，组织学分级定义为H5（癌）、H4（可能为癌）、H3（发育异常/腺瘤或恶性不确定）、H2（可能为良性）和H1（肯定为良性）。我们分析了内镜和组织活检诊断的准确性。
在E1（0/978）中，包括H3、H4和H5的肿瘤性病变发生率为0%，E2（3/132）中为2%，E3（6/31）中为19%，E4（3/9）中为33%，E5病变（34/34）中为100%。内镜诊断这些肿瘤性病变的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为94%、97%、58%、99%和97%。
在筛查内镜检查诊断上消化道癌时，更好地了解其内镜特征并进行适当的内镜活检至关重要。
