| ObjectiveUpper gastrointestinal cancer mainly refers to esophageal cancer and gastric cancer.Upper gastrointestinal malignancies make up a significant and growing segment of newly diagnosed cancers.Their morbidity and mortality are very high among the top 10 malignancies in the world.The good prognosis of upper gastrointestinal cancer is closely related to the early diagnosis and early treatment of the disease which can effectively improve the survival rate of the patients.Magnifying endoscopy with narrow-band imaging(ME-NBI)can clearly show the microstructure of the mucosal morphology and vascular pattern of the early cancer and precancerous lesions of upper gastrointestinal tract.ME-NBI has been used for diagnosed of esophageal and gastric cancers because of its accuracy and applicability.The present study mainly identified and characterized the microvascular patterns and mucosal patterns of the early esophageal and gastric cancers and their precancerous lesions,and investigated the diagnostic values and clinical significance of these patterning demonstrated by ME-NBI.MethodsThis retrospective study was performed in the Second Affiliated Hospital of Zhengzhou University from January 2015 to January 2017.139 cases of patients were diagnosed as early esophageal and gastric cancers or precancerous lesions by the pathologic results,and were enrolled in this retrospective study.There were 79 cases of early esophageal cancer and precancerous lesions,including 48 cases(60.76%)of male patients and 31 cases(39.24%)of female,and the average age was 61.92 ± 9.64 years old.There were 60 cases of early gastric cancer(EGC)and precancerous lesions,46 cases(76.67%)of male and 14 cases(22.33%)of female,and the average age was 61.03 ± 9.87 years old.All patients underwent endoscopic mucosal resection(EMR)or endoscopic submucosal dissection(ESD)treatment,and their complete clinical and pathological data were collected.All patients signed informed consent.In this study,the relationships between patient's age and sex,location,and endoscopic morphological classification of lesions were observed and analyzed.Once the lesions were detected,the morplology of the lesions,the Intrappapillary capillary loops(IPCL)in esophagus mucosa and pit patterns and blood capillary forms in gastric mucosa were observed and investigated with magnifying endoscopy(ME)and ME-NBI.The consistency between endoscopic diagnosis and pathological diagnosis was analyzed.The sensitivity and specificity of endoscopic diagnosis for esophageal and gastric cancers were evaluated.The clinical value of reform vessel-plus-surface classification(RVS)versus vessel plus surface classification(VS)for diagnosis of EGC was compared.ResultsThe most common type of endoscopic appearance for patients with early esophageal cancer and precancerous lesions was type 0-?,and the total lesions of type 0-?were 81(94.19%),of which type 0-?b were 58(67.44%).A total of 64 lesions were diagnosed as early esophageal neoplasms pathologically(74.42%).The most common endoscopic form for these lesions was type 0-?,and the total type 0-?was 60(93.75%),of which type0-?b was 39(60.94%).The lesions were commonly located at the middle part of the esophagus,which were 56 cases(65.12%)in total.There was no association between the sex of patients and location of the lesions(P >0.05,P = 0.32).The age of patients,when the lesions having been detected,were significantly associated with the location of the lesions in esophagus(P <0.05,P = 0.02).The ages of patient whose lesions were located at the middle and lower parts of esophagus were 10 years youger than those whose lesions were at upper parts of esophagus.For image resolution,NBI was significantly superior to white light image(WLI)in respect of morphology of lesions in esopgagus(P<0.001),and the ME-NBI was significantly superior to ME in respect of IPCL in esophageal lesions(P<0.001).Among the 64 esophageal neoplastic lesions diagnosed pathologically 67 lesions were endoscopically classified as ?,?1,?2,?3,and ?N types by ME-NBI.The sensitivity,specificity,positive predictive value and negative predictive value of IPCL in diagnosing early esophageal neoplastic disease were 89.06%,54.55%,85.07% and 63.15%,respectively.The endoscopic diagnosis of the lesions and their postoperative pathological were in a statistically good consistency(kappa coefficient=0.47).These results indicate that the IPCL classification has a good predictive value for early esophageal neoplastic disease diagnosis.The most common endoscopic type of EGC and its precancerous lesions was type 0-?,and the total lesions of type 0-? were 48(76.19%),of which type 0-?c were 20(31.75%).There were 44 lesions(69.84%)pathologically diagnosed as gastric neoplasms,and their most common endoscopic appearance was type 0-? form,and the total of type 0-? lesions were 33(75%),of which type 0-?c were 15(34.09%).The most common sites of the lesions were at cardia and antrum of the stomach.They had 23(36.51%)and 22(34.92%)respectively.The sex and age of patients showed no statistically association with locations of lesions in stomach(P>0.05).NBI demonstrated significantly higher image resolutiou than WLI in respect of morphology of the lesions in stomach(P<0.05).ME-NBI showed significantly superior to ME in respect of image resolution in microsurface pattern and microvascular pattern in gastric mucosa(P<0.001).The sensitivity and specificity of RVS for diagnosis of EGC were,Demarcation line as 100% and 88.1%,Irregular microvascular pattern as 85.71% and 42.86%,Irregular microsurface pattern as 80.95% and 23.81%,the density of microurface as 71.43% and 50%,microvessel density as 57.14% and 66.67%,respectively.The statistical analysis showed that the endoscopic diagnosis of the gastric lesions were in an identical consistency with their corresponding pathological results(kappa coefficient=0.86).The area under curve(AUC)of VS classification was 0.92,and the AUC of RVS was 0.91,which all had high diagnostic value for EGC diagnosis.Conclusions1.The most common form under endoscopy for early upper gastrointestinal cancer and precancerous lesions was type0-?,among which,the type0-?b was common for esophageal cancer,and type0-?c was common for EGC.2.ME-NBI was significantly superior to WLI in identifying the lesion site,morphology,pit pattern and microvascular structure in esophagus and stomach.3.IPCL classification has a good predictive value for early esophageal neoplastic diseases diagnosis.According to IPCL classification,endoscopic diagnosis and postoperative pathological results was in a good consistency.4.RVS classification can help to identify gastric neoplasms and non-neoplastic lesions,and has a high diagnostic value for ECG. |
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