Kato Minoru, Hayashi Yoshito, Uema Ryotaro, Kimura Keiichi, Inoue Takanori, Sakatani Akihiko, Yoshii Shunsuke, Tsujii Yoshiki, Shinzaki Shinichiro, Iijima Hideki, Takehara Tetsuo
Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan.
JGH Open. 2019 Aug 19;4(2):178-184. doi: 10.1002/jgh3.12246. eCollection 2020 Apr.
To investigate whether assessment by magnifying narrow-band imaging (M-NBI) based on the classification of the Japan Esophageal Society provides additional value to the estimation of the invasion depth of superficial esophageal squamous cell carcinoma (SCC) compared with assessment by white light endoscopy (WLE) alone.
Endoscopic images of 211 consecutive superficial esophageal SCCs resected by endoscopic submucosal dissection were separated into WLE and M-NBI images. Depth estimation was performed independently by five evaluators using the numerical depth estimation scale (0 = epithelium (EP)/lamina propria (LPM), 1 = EP/LPM > muscularis mucosa (MM)/shallow submucosa (SM1), 2 = MM/SM1 > EP/LPM, 3 = MM/SM1, 4 = MM/SM1 > deep submucosa (SM2), 5 = SM2 > MM/SM1, 6 = SM2), using primarily WLE images (step 1), and subsequently both WLE and M-NBI images (step 2). The discordance scores, determined by the average of the five evaluators' difference between the estimated score (from 0 to 6) and pathological score (0 for histologically proven EP/LPM, 3 for MM/SM1, and 6 for SM2), were analyzed in steps 1 and 2.
The discordance scores significantly decreased in step 2 (0.53 ± 0.06) compared with those in step 1 (0.79 ± 0.07) ( < 0.001). When the discordance score < 1.5 was regarded as a clinically correct diagnosis, the rate of the clinically correct diagnosis significantly increased in step 2 compared with that in step 1 (81% to 91%, < 0.001).
M-NBI has an additive value for estimating the invasion depth of superficial esophageal SCCs.
研究基于日本食管学会分类的放大窄带成像（M-NBI）评估相较于单纯白光内镜（WLE）评估，在浅表食管鳞状细胞癌（SCC）浸润深度估计方面是否具有额外价值。
将211例经内镜黏膜下剥离术切除的连续性浅表食管SCC的内镜图像分为WLE图像和M-NBI图像。由5名评估者分别使用数值深度估计量表（0 = 上皮层（EP）/固有层（LPM），1 = EP/LPM > 黏膜肌层（MM）/浅黏膜下层（SM1），2 = MM/SM1 > EP/LPM，3 = MM/SM1，4 = MM/SM1 > 深黏膜下层（SM2），5 = SM2 > MM/SM1，6 = SM2）独立进行深度估计，首先使用WLE图像（步骤1），随后同时使用WLE和M-NBI图像（步骤2）。分析步骤1和步骤2中由5名评估者估计分数（0至6）与病理分数（组织学证实为EP/LPM为0，MM/SM1为3，SM2为6）之间差异的平均值所确定的不一致分数。
与步骤1（0.79 ± 0.07）相比，步骤2（0.53 ± 0.06）的不一致分数显著降低（P < 0.001）。当将不一致分数 < 1.5视为临床正确诊断时，步骤2的临床正确诊断率相较于步骤1显著提高（81%至91%，P < 0.001）。
M-NBI在估计浅表食管SCC的浸润深度方面具有附加价值。
