Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Jpn J Clin Oncol. 2022 Aug 5;52(8):799-805. doi: 10.1093/jjco/hyac064.
This review focuses on the current status of endoscopic detection, characterization and tumour category staging of oesophagealsquamous cell carcinoma.
The diagnostic yield of white-light imaging is limited and narrow-band imaging has demonstrated a better performance for detecting oesophageal cancer. Narrow-band imaging has also shown similar sensitivity and superior specificity to iodine staining.
Accurate differentiation between cancerous and non-cancerous lesions can be achieved by magnifying narrow-band imaging or iodine staining with confirmation of a pink-colour sign. A per-patient analysis of a randomized study showed similar sensitivities, specificities and overall accuracies of magnifying narrow-band imaging and iodine staining of 82.2%, 95.1% and 91.2%, and 80.5%, 94.3% and 90.5%, respectively.
TUMOUR-STAGING: The diagnostic capability of endoscopic ultrasonography after conventional and narrow-band imaging in terms of tumour depth was evaluated in a multicentre prospective study. Endoscopic ultrasonography did not significantly improve the accuracy for distinguishing between mucosal or submucosal microinvasive cancer and deeper cancers from 72.9 to 74.0%, suggesting that additional endoscopic ultrasonography did not improve the diagnostic accuracy. In addition, endoscopic ultrasonography increased the incidence of overdiagnosis, defined as a diagnosis of cancer depth greater than the actual depth, by 6.6%. The risk of overdiagnosis by endoscopic ultrasonography was reconfirmed in two systematic reviews.
Narrow-band imaging is currently considered as the standard modality for the detection and characterization of oesophageal cancer. The risk of overdiagnosis should be considered when applying endoscopic ultrasonography for the evaluation of tumour invasion depth of superficial oesophageal squamous cell carcinoma.
本文主要聚焦于当前食管鳞状细胞癌的内镜检测、特征描述和肿瘤分类分期的现状。
白光成像的诊断效果有限，而窄带成像在检测食管癌方面表现出了更好的性能。窄带成像在碘染色方面也显示出了相似的敏感性和更高的特异性。
通过放大窄带成像或碘染色并确认粉红色征，可以准确地区分癌性和非癌性病变。一项随机研究的患者分析显示，放大窄带成像和碘染色的敏感性、特异性和总准确率分别为 82.2%、95.1%和 91.2%，80.5%、94.3%和 90.5%。
在一项多中心前瞻性研究中，评估了常规和窄带成像内镜超声检查在肿瘤深度方面的诊断能力。内镜超声检查并没有显著提高从 72.9%到 74.0%的区分黏膜或黏膜下微侵袭性癌与更深部癌症的准确性，表明额外的内镜超声检查并没有提高诊断准确性。此外，内镜超声检查使过度诊断（定义为诊断的癌症深度大于实际深度）的发生率增加了 6.6%。两项系统评价再次证实了内镜超声检查过度诊断的风险。
窄带成像目前被认为是检测和描述食管癌的标准方式。在评估浅表性食管鳞状细胞癌肿瘤浸润深度时，应考虑内镜超声检查过度诊断的风险。
