Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan.
Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Endoscopy. 2015 Feb;47(2):122-8. doi: 10.1055/s-0034-1390858. Epub 2015 Jan 15.
Intrapapillary capillary loops (IPCLs) have been used to estimate histopathological atypia and the invasion depth of squamous cell carcinoma (SCC). The aim of this study was to evaluate the clinical significance of IPCLs.
A total of 358 consecutive patients with esophageal neoplasia on magnifying narrow-band imaging (M-NBI) were studied. The lesions were categorized according to the IPCL classification of Inoue et al. and were subsequently resected. Resected specimens were histopathologically analyzed to determine the invasion depth. The inter- and intraobserver agreements in the interpretation of IPCL images were also investigated.
A total of 446 lesions were diagnosed on M-NBI as IPCL type V lesions, which were further classified as 185 IPCL type V1, 109 type V2, 104 type V3, and 48 type Vn. Sensitivity and specificity of IPCL type V1-2 for invasion confined to the epithelium or lamina propria mucosa (m1-2) were 89.5 % (95 % confidence interval [CI] 85.4 % - 92.7 %) and 79.6 % (95 %CI 72.3 % - 85.7 %), respectively. Sensitivity and specificity of IPCL type V3 for invasion confined to the muscularis mucosa or slight submucosal invasion (m3-sm1) were 58.7 % and 83.8 %, respectively. Sensitivity and specificity of IPCL type Vn for deeper invasion (sm2-3) were 55.8 % and 98.6 %, respectively. Interobserver agreement was substantial (κ = 0.609, 0.641, and 0.705), as was intraobserver agreement (κ = 0.705 and κ = 0.819).
Changes in the morphology of IPCLs on M-NBI correlated with the depth of SCC invasion, and results were reproducible and reliable among observers. Identification of IPCL type V1-2 proved useful for the intraprocedural identification of m1-2 lesions, which are considered an absolute indication for endoscopic resection.
内乳头状毛细血管袢（IPCLs）已被用于评估鳞状细胞癌（SCC）的组织病理学异型性和浸润深度。本研究旨在评估 IPCL 的临床意义。
对 358 例接受放大窄带成像（M-NBI）检查的食管肿瘤患者进行了研究。根据 Inoue 等人的 IPCL 分类对病变进行分类，随后进行切除。对切除标本进行组织病理学分析以确定浸润深度。还研究了观察者间和观察者内对 IPCL 图像解释的一致性。
在 M-NBI 上共诊断出 446 例 IPCL 类型 V 病变，进一步分为 185 例 IPCL 类型 V1、109 例 IPCL 类型 V2、104 例 IPCL 类型 V3 和 48 例 IPCL 类型 Vn。IPCL 类型 V1-2 对局限于上皮或固有层黏膜（m1-2）的侵袭的敏感性和特异性分别为 89.5%（95%置信区间 [CI] 85.4%-92.7%）和 79.6%（95%CI 72.3%-85.7%）。IPCL 类型 V3 对局限于黏膜肌层或轻度黏膜下侵犯（m3-sm1）的侵袭的敏感性和特异性分别为 58.7%和 83.8%。IPCL 类型 Vn 对更深侵袭（sm2-3）的敏感性和特异性分别为 55.8%和 98.6%。观察者间的一致性很高（κ=0.609、0.641 和 0.705），观察者内的一致性也很高（κ=0.705 和 κ=0.819）。
M-NBI 上 IPCL 形态的变化与 SCC 浸润深度相关，结果在观察者之间具有可重复性和可靠性。识别 IPCL 类型 V1-2 有助于术中识别 m1-2 病变，这些病变被认为是内镜切除的绝对适应证。
