Comparison of different endoscopic methods for infiltration depth of early esophageal cancer / 中华消化内镜杂志

ABSTRACT

Objective To compare the clinical value of different endoscopic methods for infiltration depth of early esophageal cancer. Methods Patients with suspected esophageal cancer, examined in Sichuan Provincial People′s Hospital from August 2013 to February 2016 were enrolled to this study. The patients underwent narrow band imaging( NBI) with magnifying endoscopy( including IPCL?type and B?type methods) and endoscopic ultrasonography(EUS) to estimate infiltration depth and then underwent iodine staining and biopsy. All lesions, which included the identified moderate?severe hyperplasia, high?grade intraepithelial neoplasia and early esophageal cancer and those which were diagnosed as possible cancer by white light and NBI with the negative pathological results, were given endoscopic or surgical procedure depending on patients′ choices. A total of 54 cases were diagnosed as early esophageal cancer, with pathological results as the gold standard. The diagnostic accuracy of invasion depth of these patients was compared by the statistic kappa values. Results Type B of NBI was highly consistent with the final pathological results(Kappa=0?802). White light endoscopy and IPCL type had poorer results(Kappa=0?596, Kappa = 0?601 ) compared with the final pathological results. However, EUS had the lowest consistency with the final pathological results( Kappa=0?132) . For the mucosal layer( M1?M2) infiltration of the esophageal cancer, type B showed the highest accuracy ( 86?7%, 26/30 ) , followed by white light endoscopy(76?7%, 23/30) and IPCL type(73?3%, 22/30). And EUS showed the lowest diagnostic accuracy(30?0%, 9/30) and the highest over?diagnostic rate(70?0%,21/30). For the cancer infiltration depth( M3?SM1 ) , type B also showed slightly higher accuracy rate ( 89?5%, 17/19 ) than IPCL type (78?9%, 15/19) and white light endoscopy (73?7%, 14/19). And EUS still showed the lowest accuracy rate( 42?1%, 8/19 ) and the highest over?diagnostic rate ( 52?6%, 10/19 ) . Conclusion White light endoscopy is still valuable for the invation depth of early esophageal cancer. But B type and IPCL?type of NBI are superior to white light endoscopy. B type presents higher accuracy rate than others, and it seems much easier to operate than IPCL?type for beginners. Accuracy rate of EUS is unsatisfactory, and the over?diagnostic rate is much higher than others. Diagnosis with EUS alone is not recommended.