Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China.
J Cancer Res Clin Oncol. 2020 Jun;146(6):1479-1488. doi: 10.1007/s00432-020-03199-6. Epub 2020 Mar 31.
Though intrapapillary capillary loops (IPCL) can be used to diagnose the staging of superficial esophageal squamous cell carcinoma (SESCC), the accuracy still remains controversial. Moreover, which IPCL classification is more suitable for clinical application is unclear. The aim was to evaluate the diagnostic performance of different IPCL classifications and to explore a new classification.
A meta-analysis was conducted to compare the diagnostic efficiency of the three IPCL classifications for SESCC staging. STATA 12.0 software was used and bivariate mixed effects-model was applied for the meta-analysis. A new classification was developed based on the meta-analysis result. Then a single-center study was conducted for further validation analysis.
Of the 2310 citations, 14 studies fulfilled our criteria. For epithelium (EP) and lamina propria mucosa (LPM) staging tumors, IPCL showed high diagnostic accuracy (Inoue: 87.17%, Arima: 98.71%, JES: 86.70%). For muscularis mucosa (MM) and submucosa (SM1), 23.12% were underestimated and the Japan Esophageal Society classification (JES) was better than Inoue (Accuracy: 75.48% VS 58.67%, P < 0.05). For ≥ SM2, 38.86% were underdiagnosed and the diagnostic accuracy of Arima classification was significantly higher than the other two (P < 0.05). Our study showed that the new criteria had higher diagnostic sensitivity than the widely used classification (JES) for differentiating ≥ SM2 staging cancer from EP-SM1 (0.77 VS 0.50, P < 0.05).
IPCL was valuable for diagnosing SESCC staging. However, ≥ MM would be underestimated easily. Our study revealed that the diagnostic sensitivity for ≥ SM2 staging tumors was significantly improved by the new standard.
虽然腔内毛细血管袢（IPCL）可用于诊断浅表性食管鳞状细胞癌（SESCC）的分期，但准确性仍存在争议。此外，哪种 IPCL 分类更适合临床应用尚不清楚。本研究旨在评估不同 IPCL 分类的诊断性能，并探索一种新的分类方法。
对比较三种 IPCL 分类用于 SESCC 分期的诊断效率的研究进行了荟萃分析。使用 STATA 12.0 软件进行双变量混合效应模型的荟萃分析。基于荟萃分析结果开发了一种新的分类方法。然后进行了一项单中心研究以进行进一步的验证分析。
从 2310 篇文献中，有 14 项研究符合我们的标准。对于上皮（EP）和固有层黏膜（LPM）分期肿瘤，IPCL 显示出较高的诊断准确性（Inoue：87.17%，Arima：98.71%，JES：86.70%）。对于黏膜肌层（MM）和黏膜下层（SM1），低估了 23.12%，日本食管学会分类（JES）优于 Inoue（准确性：75.48% VS 58.67%，P<0.05）。对于≥SM2，低估了 38.86%，Arima 分类的诊断准确性明显高于其他两种（P<0.05）。我们的研究表明，与广泛使用的分类（JES）相比，新的分类标准在区分≥SM2 分期癌症与 EP-SM1 方面具有更高的诊断敏感性（0.77 VS 0.50，P<0.05）。
IPCL 对诊断 SESCC 分期有价值。然而，容易低估≥MM。本研究表明，新标准显著提高了≥SM2 分期肿瘤的诊断敏感性。
