Department of Gastroenterology, Division of South Building, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
World J Gastroenterol. 2012 Mar 28;18(12):1295-307. doi: 10.3748/wjg.v18.i12.1295.
Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis. Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as curative treatments for many early-stage GI lesions in recent years. The technologies have been widely accepted in many Asian countries because they are minimally invasive and supply thorough histopathologic evaluation of the specimens. However, before engaging in endoscopic therapy, an accurate diagnosis is a precondition to effecting the complete cure of the underlying malignancy or carcinoma in situ. For the past few years, many new types of endoscopic techniques, including magnifying endoscopy with narrow-band imaging (ME-NBI), have emerged in many countries because these methods provide a strong indication of early lesions and are very useful in determining treatment options before ESD or EMR. However, to date, there is no comparable classification equivalent to "Kudo's Pit Pattern Classification in the colon", for the upper GI, there is still no clear internationally accepted classification system of magnifying endoscopy. Therefore, in order to help unify some viewpoints, here we will review the defining optical imaging characteristics and the current representative classifications of microvascular and microsurface patterns in the upper GI tract under ME-NBI, describe the accurate relationship between them and the pathological diagnosis, and their clinical applications prior to ESD or en bloc EMR. We will also discuss assessing the differentiation and depth of invasion, defying the lateral spread of involvement and targeting biopsy in real time.
胃肠道（GI）癌症的任何预后都与诊断时疾病的阶段密切相关。近年来，内镜黏膜下剥离术（ESD）和整块内镜黏膜切除术（EMR）已被用作许多早期胃肠道病变的治愈性治疗方法。这些技术在许多亚洲国家被广泛接受，因为它们具有微创性，并提供对标本的彻底组织病理学评估。然而，在进行内镜治疗之前，准确的诊断是实现潜在恶性肿瘤或原位癌完全治愈的前提。在过去的几年中，许多国家出现了许多新型内镜技术，包括窄带成像放大内镜（ME-NBI），因为这些方法对早期病变具有强烈的指示作用，在决定 ESD 或 EMR 之前的治疗选择非常有用。然而，迄今为止，在上消化道中，还没有类似于“结肠的 Kudo's Pit 模式分类”的可比分类，也没有明确的国际公认的放大内镜分类系统。因此，为了帮助统一一些观点，我们在这里将回顾 ME-NBI 下上消化道微血管和微表面模式的定义光学成像特征和当前代表性分类，描述它们与病理诊断之间的准确关系，以及在 ESD 或整块 EMR 之前的临床应用。我们还将讨论评估分化和浸润深度、实时抵抗受累的侧向扩散以及靶向活检。
