Gastroenterology Division, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
Pole de Santé Publique, Statistics and Medical Research Department, Hospices Civils de Lyon, Lyon, France.
Endoscopy. 2021 Jul;53(7):674-682. doi: 10.1055/a-1224-6822. Epub 2020 Oct 1.
Narrow-band imaging (NBI) is as sensitive as Lugol chromoendoscopy to detect esophageal squamous cell carcinoma (SCC) but its specificity, which appears higher than that of Lugol chromoendoscopy in expert centers, remains to be established in general practice. This study aimed to prove the superiority of NBI specificity over Lugol chromoendoscopy in the detection of esophageal SCC and high grade dysplasia (HGD) in current general practice (including tertiary care centers, local hospitals, and private clinics).
This prospective randomized multicenter trial included consecutive patients with previous or current SCC of the upper aerodigestive tract who were scheduled for gastroscopy. Patients were randomly allocated to either the Lugol or NBI group. In the Lugol group, examination with white light and Lugol chromoendoscopy were successively performed. In the NBI group, NBI examination was performed after white-light endoscopy. We compared the diagnostic characteristics of NBI and Lugol chromoendoscopy in a per-patient analysis.
334 patients with history of SCC were included and analyzed (intention-to-treat) from 15 French institutions between March 2011 and December 2015. In per-patient analysis, sensitivity, specificity, positive and negative likelihood values were 100 %, 66.0 %, 21.2 %, and 100 %, respectively, for Lugol chromoendoscopy vs. 100 %, 79.9 %, 37.5 %, and 100 %, respectively, for NBI. Specificity was greater with NBI than with Lugol ( = 0.002).
As previously demonstrated in expert centers, NBI was more specific than Lugol in current gastroenterology practice for the detection of early SCC, but combined approaches with both NBI and Lugol could improve the detection of squamous neoplasia.
窄带成像（NBI）在检测食管鳞状细胞癌（SCC）方面与卢戈氏碘染色内镜检查一样敏感，但在专家中心，其特异性似乎高于卢戈氏碘染色内镜检查，这一结果在常规实践中仍有待证实。本研究旨在证明在当前的常规实践（包括三级护理中心、当地医院和私人诊所）中，NBI 特异性在检测食管 SCC 和高级别上皮内瘤变（HGD）方面优于卢戈氏碘染色内镜检查。
这是一项前瞻性随机多中心试验，纳入了既往或当前上呼吸道 SCC 患者，这些患者拟行胃镜检查。患者被随机分配到卢戈氏碘染色组或 NBI 组。在卢戈氏碘染色组中，白光和卢戈氏碘染色内镜检查依次进行。在 NBI 组中，在白光内镜检查后进行 NBI 检查。我们比较了 NBI 和卢戈氏碘染色内镜检查在患者个体水平上的诊断特征。
2011 年 3 月至 2015 年 12 月，来自 15 家法国机构的 334 例 SCC 病史患者被纳入并进行了意向治疗分析。在患者个体水平上，卢戈氏碘染色内镜检查的敏感性、特异性、阳性和阴性似然值分别为 100%、66.0%、21.2%和 100%，而 NBI 检查的敏感性、特异性、阳性和阴性似然值分别为 100%、79.9%、37.5%和 100%。NBI 的特异性大于卢戈氏碘染色（ = 0.002）。
与专家中心的先前研究结果一致，在当前的消化内镜实践中，NBI 比卢戈氏碘染色在检测早期 SCC 方面更具特异性，但结合 NBI 和卢戈氏碘染色两种方法可能会提高对鳞状上皮肿瘤的检出率。
