Value Of Iodine Staining,NBI And Endoscopic Ultrasonography In Preoperative Evaluation Of ESD In Early Esophageal Lesions

Background:The stage of esophageal cancer is closely related to the prognosis.At present,there is no circulating marker with sufficient sensitivity and specificity for the diagnosis of esophageal cancer.Endoscopic biopsy is the gold standard for the diagnosis of esophageal cancer.The early-stage esophageal cancer is expected to be cured by endoscopic therapy,and the five-year survival rate can be as high as 90%.Endoscopic submucosal dissection(ESD)is the preferred method for the treatment of early esophageal cancer and precancerous lesions.To strictly grasp the surgical indications and achieve complete dissection of the lesions,in addition to improving the preoperative pathological examination,it is of great significance to comprehensively evaluate the scope and depth of the lesions under endoscopy.Objective:To study the application of iodine staining,narrow-band imaging,and ultrasound in the perioperative period of ESD in early esophageal squamous cell carcinoma and precancerous lesions,and to preliminarily analyze which factors are related to the positive margin of ESDs specimens.Methods:Clinicopathological data of patients with early-stage esophageal squamous cell carcinoma and its precancerous lesions by ESD were collected from January 2014 to December 2020 in Taihe Hospital of Shiyan City.The postoperative pathological findings were used as the gold standard for lesion diagnosis.To compare the accuracy of ME-NBI and EUS in determining the depth of infiltration of lesions;to compare whether there is any difference between NBI and iodine staining endoscopy for the diagnosis rate and scope of lesions;to preliminarily analyze which factors are associated with positive cut margins of specimens after ESD surgery.Results:The overall diagnostic rates of NBI and iodine staining endoscopy for early esophageal squamous cell carcinoma and precancerous lesions were 97.8%(221/226)and 100.0%(226/226).The diagnostic rate of NBI endoscopy for early esophageal squamous cell carcinoma was the same as that of iodine staining endoscopy.The diagnostic rate of NBI endoscopy in esophageal precancerous lesions was lower than iodine staining endoscopy,and the difference was not statistically significant(P>0.05).The lesion ranges under NBI and iodine staining were 2.88±1.40cm and3.22±1.65cm,respectively.The lesion ranges under iodine staining were wider for some lesions,and the difference was statistically significant(P<0.05).The accuracy of ME-NBI in judging the infiltration depth of early esophageal cancer and its precancerous lesions was higher than that of endoscopic ultrasonography,and the difference was statistically significant(P<0.05).The size of the postoperative specimen for the patients with positive margins was 14.75±9.03cm~2,and the size of the postoperative specimen for the patients with negative margins was 6.93±5.47cm~2,with statistical significance(P<0.05).There was no significant difference in lesion size between positive horizontal margin and positive basal margin(P>0.05).Conclusion:It is recommended that patients with non-hyperthyroidism and hypersensitivity should be treated with total esophageal iodine staining combined with ME-NBI examination before ESD,in order to determine the boundary range of lesions,the depth of infiltration and reduce missed diagnosis.The application of endoscopic ultrasonography alone has certain limitations.If the lesion scope is too large,intraoperative procedures should be more careful to reduce the occurrence of positive margins.