Ono Yoichiro, Takaki Yasuhiro, Yao Kenshi, Ishikawa Satoshi, Miyaoka Masaki, Yano Yutaka, Nagahama Takashi, Hisabe Takashi, Hirai Fumihito, Ueki Toshiharu, Ota Atsuko, Tanabe Hiroshi, Haraoka Seiji, Iwashita Akinori, Mikami Koji, Maekawa Takafumi
Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Department of Gastroenterology, Ashiya Central Hospital, Kitakyusyu, Japan.
Endosc Int Open. 2020 Mar;8(3):E234-E240. doi: 10.1055/a-1072-4676. Epub 2020 Feb 21.
Magnifying endoscopy with narrow-band imaging (M-NBI) is reported to be useful in diagnosing invasion depth of superficial esophageal squamous cell carcinoma (SCC), but accurate diagnosis of deep submucosal invasion (SM2) has remained difficult. However, we discovered that irregularly branched microvessels observed with M-NBI are detected in SM2 cancers with high prevalence. Thus, this retrospective study aimed to investigate the diagnostic performance of irregularly branched microvessels as visualized by M-NBI for predicting SM2 cancers. Patients with superficial esophageal SCC lesions that were endoscopically or surgically resected at our hospital between September 2005 and December 2014 were included. Endoscopic findings by M-NBI of these lesions were presented to an experienced endoscopist who was unaware of the histopathological diagnosis and who then judged whether irregularly branched microvessels were present. Using the invasion depth according to postoperative histopathological diagnosis as the gold standard, we determined the diagnostic performance of the presence of irregularly branched microvessels as an indicator for SM2 cancers. A total of 302 superficial esophageal SCC lesions (228 patients) were included in the analysis. When irregularly branched microvessels were used as an indicator of SM2 cancers, the diagnostic accuracy was 94.0 % (95 % confidence interval [CI]: 91.1-96.1 %), sensitivity was 79.4 % (95 % CI: 66.6-88.4 %), specificity was 95.9 % (95 % CI: 94.3-97.0 %), positive predictive value was 71.1 % (95 % CI: 59.6-79.1 %), and negative predictive value was 97.3 % (95% CI: 95.7-98.5 %). Irregularly branched microvessels may be a reliable M-NBI indicator for the diagnosis of cancers with deep submucosal invasion.
据报道，窄带成像放大内镜检查（M-NBI）有助于诊断浅表性食管鳞状细胞癌（SCC）的浸润深度，但对深层黏膜下浸润（SM2）的准确诊断仍然困难。然而，我们发现M-NBI观察到的不规则分支微血管在SM2癌中具有较高的检出率。因此，本项回顾性研究旨在探讨M-NBI观察到的不规则分支微血管对预测SM2癌的诊断性能。纳入2005年9月至2014年12月期间在我院接受内镜或手术切除的浅表性食管SCC病变患者。这些病变的M-NBI内镜检查结果呈现给一位经验丰富的内镜医师，该医师不知道组织病理学诊断结果，然后判断是否存在不规则分支微血管。以术后组织病理学诊断的浸润深度作为金标准，我们确定了存在不规则分支微血管作为SM2癌指标的诊断性能。分析共纳入302个浅表性食管SCC病变（228例患者）。当将不规则分支微血管用作SM2癌的指标时，诊断准确性为94.0%（95%置信区间[CI]：91.1-96.1%），敏感性为79.4%（95%CI：66.6-88.4%），特异性为95.9%（95%CI：94.3-97.0%），阳性预测值为71.1%（95%CI：59.6-79.1%），阴性预测值为97.3%（95%CI：95.7-98.5%）。不规则分支微血管可能是诊断深层黏膜下浸润癌的可靠M-NBI指标。
