Prueksapanich Piyapan, Luangsukrerk Thanawat, Pittayanon Rapat, Sanpavat Anapat, Rerknimitr Rungsun
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Division of General Internal Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Clin Endosc. 2019 Mar;52(2):144-151. doi: 10.5946/ce.2018.091. Epub 2018 Oct 5.
BACKGROUND/AIMS: This study aimed to evaluate the diagnostic accuracy of dual-focus narrow-band imaging (dNBI) and Lugol'schromoendoscopy (LCE) combined with probe-based confocal laser endomicroscopy (pCLE) to screen for esophageal squamous cell neoplasms (ESCNs) in patients with a history of head and neck cancer.
From March to August 2016, dNBI was performed. Next, LCE was performed, followed by pCLE and biopsy. Histology has historically been the gold standard to diagnose ESCN. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of dNBI and LCE adjunct with pCLE were determined.
Twenty-four patients were included. Ten ESCNs were found in 8 patients (33%). Forty percent of high-graded intraepithelial neoplasias and all low-grade intraepithelial neoplasias were overlooked by dNBI. The sensitivity, specificity, PPV, NPV, and accuracy of dNBI vs. LCE combined with pCLE were 50% vs. 80%, 62% vs. 67%, 36% vs. 44%, 75% vs. 91%, and 83% vs. 70%, respectively.
The use of dNBI to detect ESCN was suboptimal. LCE with pCLE following dNBI had additional value for detecting esophageal dysplasia not detected by dNBI. The use of pCLE to detect dNBI-missed lesions yielded a high NPV, while pCLE-guided biopsy could reduce the number of unnecessary biopsies.
背景/目的：本研究旨在评估双焦点窄带成像（dNBI）、卢戈氏染色内镜检查（LCE）联合基于探头的共聚焦激光显微内镜检查（pCLE）对头颈部癌患者食管鳞状细胞瘤（ESCNs）的诊断准确性。
2016年3月至8月，进行dNBI检查。接下来，进行LCE检查，随后进行pCLE检查和活检。组织学一直是诊断ESCN的金标准。确定dNBI和LCE联合pCLE的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。
纳入24例患者。8例患者（33%）中发现10例ESCNs。dNBI漏诊了40%的高级别上皮内瘤变和所有低级别上皮内瘤变。dNBI与LCE联合pCLE的敏感性、特异性、PPV、NPV和准确性分别为50%对80%、62%对67%、36%对44%、75%对91%和83%对70%。
使用dNBI检测ESCN并不理想。dNBI后进行LCE联合pCLE对于检测dNBI未发现的食管发育异常具有额外价值。使用pCLE检测dNBI漏诊的病变具有较高的NPV，而pCLE引导下的活检可减少不必要的活检数量。
