Ishihara Ryu, Tani Yasuhiro, Okubo Yuki, Asada Yuya, Ueda Tomoya, Kitagawa Daiki, Ninomiya Takehiro, Tamashiro Atsuko, Yoshii Shunsuke, Shichijo Satoki, Kanesaka Takashi, Yamamoto Sachiko, Takeuchi Yoji, Higashino Koji, Uedo Noriya, Michida Tomoki
Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan.
Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Gunma Japan.
DEN Open. 2023 Jul 17;4(1):e273. doi: 10.1002/deo2.273. eCollection 2024 Apr.
Individual treatment strategies for esophageal cancer have been investigated based on the anatomical subsite classification. Accurate subsite classification based on these anatomical landmarks is thus important. We investigated the suitability of the existing endoscopic classification and explored alternative landmarks for esophageal subsite classification.
Patients who received endoscopic ultrasonography (and computed tomography scans for surveillance of esophageal cancer treatment or esophageal submucosal tumors were included. Distances between anatomical landmarks, including the inferior cricoid cartilage border, superior border of the sternum, and tracheal bifurcation, were measured using a combination of endoscopic ultrasonography, computed tomography, and other information.
The mean (standard deviation) distances from the superior incisor dentition to the pharynx-esophagus, cervical-upper thoracic esophagus, and upper-middle thoracic esophagus boundaries were 16.9 (1.7), 21.7 (1.9), and 29.0 (1.9) cm, respectively. However, variances in the differences between the mean and individual distances were large (2.8, 3.4, and 3.7, respectively), mainly because of differences in body height. However, variances in the differences between individual distances and novel endoscopic landmarks, including the lower end of the pyriform sinus and lower end of compression of the left main bronchus, were lower (1.7, 1.2, and 0.6, respectively).
Existing indicators of esophageal subsite boundaries were not consistent with anatomical boundaries. Modification of the distance from the superior incisor dentition based on average distances from anatomical landmarks or the use of alternative endoscopic landmarks is recommended to provide more suitable anatomical boundaries.
基于解剖亚部位分类对食管癌的个体化治疗策略进行了研究。因此，基于这些解剖标志进行准确的亚部位分类很重要。我们研究了现有内镜分类的适用性，并探索了用于食管亚部位分类的替代标志。
纳入接受内镜超声检查（以及用于食管癌治疗监测或食管黏膜下肿瘤的计算机断层扫描）的患者。使用内镜超声、计算机断层扫描和其他信息相结合的方法测量包括环状软骨下缘、胸骨上缘和气管隆突在内的解剖标志之间的距离。
从上门齿到咽食管、颈段-上胸段食管和上胸段-中胸段食管边界的平均（标准差）距离分别为16.9（1.7）、21.7（1.9）和29.0（1.9）cm。然而，平均距离与个体距离之间差异的方差较大（分别为2.8、3.4和3.7），主要是由于身高差异。然而，个体距离与新的内镜标志（包括梨状窝下端和左主支气管压迫下端）之间差异的方差较小（分别为1.7、1.2和0.6）。
现有的食管亚部位边界指标与解剖边界不一致。建议根据解剖标志的平均距离修改从上门齿的距离，或使用替代的内镜标志，以提供更合适的解剖边界。
