超声内镜及放大内镜在早期食管癌术前分期评估中的应用价值  

The value of ultrasound endoscopy and magnifying endoscopy in the preoperative staging evaluation of early esophageal cancer

作　　者：魏蕊蕊 郭亚 赵洁 冯洁[2] 汤泊夫 黄晓俊[1,2] WEI Ruirui;GUO Ya;ZHAO Jie;FENG Jie;TANG Bofu;HUANG Xiaojun(The Second Clinical Medical College of Lanzhou University,Lanzhou 730000;Department of Gastroenterology,the Second Hospital of Lanzhou University,China)

机构地区：[1]兰州大学第二临床医学院,甘肃兰州730000 [2]兰州大学第二医院消化内科,甘肃兰州730000

出　　处：《胃肠病学和肝病学杂志》2025年第4期499-503,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：甘肃省药监局2022年度药品监管科学立项项目(2022GSMPA0016;2022GSMPA0015)。

摘　　要：目的对比超声内镜(ultrasound endoscopy,EUS)、窄带成像联合放大内镜(narrow-band imaging combined with magnification endoscopy,ME-NBI)术前分期结果与内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)后病理结果,分析EUS、ME-NBI对早期食管癌(early esophageal cancer,EEC)病灶浸润深度的诊断价值。方法回顾性分析2018年1月至2024年7月兰州大学第二医院行ESD手术治疗且术后病理为食管癌的142例患者的临床病理资料。根据术前内镜检查分为EUS组(n=105)和ME-NBI组(n=124),记录两组患者内镜下浸润深度,评价其与术后病理结果的一致性及准确率。结果EUS组105例患者诊断为M_(1)/M_(2)者76例,M_(3)者24例,SM者5例,与病理结果比较诊断准确率分别为96.1%、25.0%、100%;ME-NBI组124例患者诊断为A/B 1者97例,B_(2)/B_(3)者27例,与病理结果比较诊断准确率分别为81.4%、38.5%。EUS组检查结果与术后病理结果总体一致性较高(Kappa=0.518),而ME-NBI组与术后病理结果总体一致性较低(Kappa=0.182)。EUS组与ME-NBI组总体诊断误判率分别为20.0%、28.2%,EUS组低于ME-NBI组(P<0.05)。结论EUS与ME-NBI均可用于内镜下治疗前评估EEC浸润深度,两者联合对EEC诊断及其浸润深度评估具有较高价值。Objective To compare the preoperative staging results of ultrasound endoscopy(EUS)and narrow-band imaging combined with magnification endoscopy(ME-NBI)with the postoperative pathological results from endoscopic submucosal disection(ESD),and to analyze the diagnostic value of EUS and ME-NBI for the infiltration depth of lesions in early esophageal cancer(EEC).Methods The clinicopathologic data of 142 patients who underwent ESD surgical treatment and whose postoperative pathology was esophageal cancer in the Second Hospital of Lanzhou University from Jan.2018 to Jun.2024 were retrospectively analyzed.The patients were divided into EUS group(n=105)and ME-NBI group(n=124)according to preoperative endoscopy.The infiltration depths recorded for both groups were compared with postoperative pathological findings to evaluate the consistency and accuracy.Results In the EUS group,105 patients were diagnosed as M_(1)/M_(2)in 76 cases,M_(3)in 24 case and SM in 5 cases,and the diagnostic accuracies were 96.1%,25.0%and 100%,respectively,when compared with the pathologic results.In the ME-NBI group,among 124 patients,97 were diagnosed as A/B_(1)and 27 as B_(2)/B_(3),resulting in diagnostic accuracies rates of 81.4%and 38.5%,respectively.The overall consistency between the EUS findings and postoperative pathology results was high(Kappa=0.518),whereas ME-NBI showed lower overall cosistency with pathological results(Kappa=0.182).The overall diagnostic misclassification rate were 20.0%in the EUS group and 28.2%in the ME-NBI group,respectively,with the EUS group naving a lower rate than the ME-NBI group(P<0.05).Conclusion Both EUS and ME-NBI can be used for assessing the infiltration depth of EEC before endoscopic treatment.The combination of the two methods has high value for the diagnosis of EEC and its infiltration depth.

关 键 词：超声内镜 窄带成像联合放大内镜 早期食管癌 浸润深度 

分 类 号：R735.1[医药卫生—肿瘤] R571[医药卫生—临床医学]