Okumura Koichi, Hojo Yudai, Tomita Toshihiko, Kumamoto Tsutomu, Nakamura Tatsuro, Kurahashi Yasunori, Ishida Yoshinori, Hirota Seiichi, Miwa Hiroto, Shinohara Hisashi
Division of Upper GI, Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan.
Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan.
J Clin Med. 2021 Jul 29;10(15):3371. doi: 10.3390/jcm10153371.
The surgical strategy for esophagogastric junction (EGJ) cancer depends on the tumor location as measured relative to the EGJ line. The purpose of this study was to clarify the accuracy of diagnostic endoscopy in different clinicopathological backgrounds.
Subjects were 74 consecutive patients with abdominal esophagus to upper gastric cancer who underwent surgical resection. Image-enhanced endoscopy with narrow-band imaging (NBI) was used to determine the EGJ line, prioritizing the presence of palisade vessels, followed by the upper end of gastric folds, as a landmark. The relative positional relationship between the tumor epicenter and the EGJ line was classified into six categories, and the agreement between endoscopic and pathologic diagnoses was examined to evaluate prediction accuracy.
The concordance rate of 69 eligible cases was 87% with a kappa coefficient () of 0.81. The palisade vessels were observed in 62/69 patients (89.9%). Of the 37 pathological EGJ cancers centered within 2 cm above and below the EGJ line, Barrett's esophagus was found to be a significant risk factor for discordance (risk ratio, 4.40; = 0.042); the concordance rate of 60% ( = 0.50) in the Barrett's esophagus group was lower than the rate of 91% ( = 0.84) in the non-Barrett's esophagus group. In five of six discordant cases, the EGJ line was estimated to be proximal to the actual line.
Diagnostic endoscopy is beneficial for estimating the location of EGJ cancer, with a risk of underestimating esophageal invasion length in patients with Barrett's esophagus.
食管胃交界部（EGJ）癌的手术策略取决于肿瘤相对于EGJ线的位置。本研究的目的是阐明在不同临床病理背景下诊断性内镜检查的准确性。
研究对象为74例连续接受手术切除的腹段食管至胃上部癌患者。采用窄带成像（NBI）的图像增强内镜检查来确定EGJ线，优先以栅栏状血管的存在为依据，其次以上胃皱襞的上端为标志。将肿瘤中心与EGJ线的相对位置关系分为六类，并检查内镜诊断与病理诊断之间的一致性以评估预测准确性。
69例符合条件的病例的一致性率为87%，kappa系数（κ）为0.81。69例患者中有62例（89.9%）观察到了栅栏状血管。在37例病理诊断为EGJ癌且肿瘤中心位于EGJ线上方和下方2 cm范围内的病例中，发现巴雷特食管是不一致的一个重要危险因素（风险比，4.40；P = 0.042）；巴雷特食管组的一致性率为60%（κ = 0.50），低于非巴雷特食管组的91%（κ = 0.84）。在6例不一致的病例中有5例，EGJ线被估计在实际线的近端。
诊断性内镜检查有助于估计EGJ癌的位置，但对于巴雷特食管患者存在低估食管侵犯长度的风险。
