Application Of Endoscopic Ultrasonography,magnifying Endoscopy With Narrow-band Imaging And Optical Coherence Tomography For Diagnosing And Staging Esophageal Cancer

[Background]Esophageal cancer is a common malignant tumors in China.Patients will receive different therapeutic measures because of different staging and their prognosis and quality of life are also very different.therefore, it is important to identify early lesions and actualize preoperative staging accurately.Analyzing the current clinical examinations,EUS could describe the full-thickness of esophageal wall and adjacent tissue visually,NBI-ME is useful in diagnosis and preoperative staging of early esophageal cancer,they are widely used and become research hotspots.However, these methods have various shortcomings and endoscopists are still looking for better inspection technique.In recent years,coherence tomography technology gained more attention because of its advantages of high-resolution imaging. [Objective]1.To investigate the value of EUS in diagnosing preoperative T and N stageing of esophageal cancer.2.To investigate the value of NBI-ME in diagnosing early esophageal squamous cell carcinoma and precancerous lesions.3.To investigate the value of OCT in imaging esophageal wall and diagnosing early esophageal cancer.[Methods]1.A total of 229 esophageal cancer patients who received EUS examination before surgery in our hospital were reviewed from Oct 2011 to Sept 2013,and the EUS T and N staging were compared with the pathological T and N staging.2.A total of 127 early esophageal cancer or high grade intraepithelial neoplasia patients who received NBI-ME examination were reviewed from Jun 2013 to Dec 2015,and these lesions were evaluated by Inoue IPCL typing and the Japan Esophageal Society recommends typing.All patients received endoscopic therapy or surgery and the NBI-ME findings were compared with pathologic infiltrative depth.3.As a marker,titanium dioxide was injected into different fresh porcine esophagael wall layers.These marks were highly reflective in OCT images and black in pathology specimens.We determined the correspondence between OCT images and biological structures by identifying these markers.4.Esophageal ESD postoperative specimens were scanned in OCT systems.To investigate the imaging rule,we collected the OCT images of lesion site and normal site and reviewed the pathological specimens. [Results]1.The preoperative T staging accuracy rates by EUS examination were59.8%( 137/229),respectively{T1 21.9%(7/32)、T2 39.2%(20/51)、T3 78.6%(110/140)、T4 0(0/6)}. The N staging accuracy rates by EUS examination were 60.3%(138/229). T3 tumors preoperative staging accuracy was significantly higher than other staging.2. The recognition accuracy for malignant lesions is 98.43% by NBIME and the staging accuracy is 83.46%.NBI-ME could boost a 85% increase in accuracy of biopsies.Under the same conditions,the diagnostic accuracy rate of early esophageal squamous cell carcinoma and precancerous lesions is 74.34%(84/113) by Inoue IPCL typing and 81.42%(92/113) by Japan Esophageal Society typing.3.The OCT image of the porcine esophageal wall has a clear four-layered morphology(slightly weak reflective layer, highly reflective layer, weak reflective layer, slightly stronger reflective layer)corresponding to pathological structures(epithelium, lamina propria, muscularis mucosa, submucosa). We observed similar structures on the human esophageal mucosa OCT image and early cancer lesions have specific performances such as hierarchy disorders. The staging accuracy of early esophageal squamous cell carcinoma and precancerous lesions is 80.95%(17/21) by OCT.[Conclusions]1.EUS has unsatisfactory reference value in diagnosing preoperative T and N staging of esophageal cancer and inferior reference value in diagnosing early esophageal cancer.2.NBI-ME is helpful in diagnosing early esophageal cancer and precancerous lesions and Japan Esophageal Society IPCL typing is more valuable.3.Optical coherence tomography could imaging porcine and human esophagus mucosa with high-resolution in real-time and it is helpful in diagnosing early esophageal cancer.