首都医科大学学报 ›› 2022, Vol. 43 ›› Issue (2): 210-215.doi: 10.3969/j.issn.1006-7795.2022.02.008

• 消化内镜应用进展 • 上一篇    下一篇

窄带成像技术联合放大内镜JES分型对早期食管癌的诊断价值

李雪, 邢洁, 张倩, 李鹏, 吕富靖, 张澍田*   

  1. 首都医科大学附属北京友谊医院消化内科 国家消化系统疾病临床医学研究中心 北京市消化疾病中心 消化疾病癌前病变北京市重点实验室,北京 100050
  • 收稿日期:2021-12-21 出版日期:2022-04-21 发布日期:2022-04-14
  • 基金资助:
    国家重点研发计划(2017YFC0109805), 北京市医院管理中心消化内科学科协同发展中心重点专项项目(XXZ01, XXZ02)。

Diagnostic value of Japan Esophageal Society classification through narrow-band imaging technology combined with magnifying endoscopy for early esophageal cancer

Li Xue, Xing Jie, Zhang Qian, Li Peng, Lyu Fujing, Zhang Shutian*   

  1. Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases; Beijing Digestive Disease Center; Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China
  • Received:2021-12-21 Online:2022-04-21 Published:2022-04-14
  • Contact: *E-mail:zhangshutian@ccmu.edu.cn
  • Supported by:
    National Key Research and Development Program of China (2017YFC0109805), Key Special Project of the Collaborative Development Center of Gastroenterology Department of Beijing Hospital Management Center (XXZ01, XXZ02).

摘要: 目的 探讨放大内镜日本食道学会(Japan Esophageal Society,JES)分型对早期食管癌的诊断价值。方法 回顾性收集2014年1月至 2020年10月于首都医科大学附属北京友谊医院行白光内镜检查高度疑似早期食管癌病灶或经活检证实为早期食管癌的203处病灶,所有病灶均行放大内镜窄带成像(narrow-band imaging magnifying endoscopy,NBI-ME)检查,并接受内镜或手术治疗,以术后病理结果作为“金标准”,分析放大内镜下JES分型对早期食管癌浸润深度的诊断价值。结果 NBI-ME模式下JES分型B1型、B2型判断早期食管癌准确度分别为63.5%(95%CI:63.3%~63.8%)和71.9%(95%CI:71.7%~72.1%),灵敏度分别为65.7%(95%CI:58.0%~73.5%)和75.0%(95%CI:60.0%~90.0%),特异度分别为58.3%(95%CI 45.9%~70.8%)和71.3%(95%CI:64.6%~78.1%)。比较放大内镜JES分型及术后病理判断病变浸润深度的一致性,Kappa值为0.25,差异有统计学意义(P<0.01)。结论 JES分型能够诊断早期食管癌和预测肿瘤浸润深度,但效果欠佳,预测结果与金标准一致性较低,需要更多多中心大样本对照研究进一步论证。

关键词: 早期食管癌, 内镜治疗, 肿瘤浸润深度, 准确度

Abstract: Objective To assess the value of narrow-band imaging (NBI) technology combined with magnifying endoscopy (ME) Japan Esophageal Society(JES)classification in the diagnosis of early esophageal cancer. Methods We retrospectively collected 203 suspected early esophageal cancer lesions found by white light endoscopy or biopsy. All lesions were conducted narrow-band imaging magnifying endoscopy(NBI-ME) examination and received endoscopic or surgical treatment in Beijing Friendship Hospital, Capital Medical University from January 2014 to October 2020. The value of JES classification for the diagnosis of invasion depth was analyzed with postoperative histopathology as the “gold standard”. Results The accuracy of JES classification B1 and B2 under NBI-ME in prediction the depth of invasion of early esophageal cancer were 63.5%(95%CI:63.3%-63.8%) and 71.9% (95%CI:71.7%-72.1%), the sensitivity were 65.7% (95%CI:58.0%-73.5%) and 75.0% (95%CI:60.0%-90.0%), and the specificity were 58.3% (95%CI 45.9%-70.8%) and 71.3% (95%CI:64.6%-78.1%), respectively. Comparing the consistency of JES classification under NBI-ME and postoperative pathology to determine the depth of lesions, Kappa value was 0.25 with statistical difference (P<0.01). Conclusion To a certain extent, JES classification could diagnose and predict the depth of early esophageal cancer, with a limited consistency between the prediction results and the gold standard. It is necessary to improve JES classification with more large-sample controlled studies of multi-center large samples.

Key words: early esophageal cancer, endoscopic treatment, depth of tumor invasion, accuracy

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