The Clinical Application Value Of Narrow-band Imaging Endoscopy In The Diagnosis Of Early Hypopharyngeal And Esophageal Cancer

Background:Fujian Province is a high incidence area of esophageal squamous cell carcinoma.The incidence and mortality are higher than the national level.The hypopharynx mucosa and esophageal mucosa are squamous epithelium,there may be certain relevance between them in the incidence of squamous cell carcinoma,and may be the same pathogenesis.Methods:A total of 78 patients with Pharyngeal or esophageal lesions were selected.Endoscopy(Olympus GIF-XQ260 or GIF-Q260J)in the white light and NBI models were used to observe the suspicious lesions.Recorded the position,size,mucosal form and surface condition of the lesion and noted the ratings of NBI grades and clarity.Dye the esophagus and hypopharynx with lugol iodide;Records of the positive parts,size,mucous membrane,Clarity grade and surface of iodine liquid.Histologic examination of all positive lesion 2 to 3 tissue.The diagnostic criteria were evaluated by pathological results.The sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,correct diagnosis were Indexed to evaluate the detection of the ordinary white light,NBI and iodine staining in the early hypopharynx?early esophageal cancerandprecancerous lesions.The consistency check of NBI and iodide staining and pathological classification were performed.Results:(a)There were 86 lesions detected by the three methods,40 of which were histopathologically confirmed to be squamous cell carcinoma and precancerous lesions.Sensitivity,specificity,the rate of missed diagnosis,misdiagnosis rate,and diagnosis rate of conventional white light endoscopy in the diagnosis of early carcinoma and precancerous lesions were 65%,50%,35%,50% and 15%,respectively.Sensitivity,specificity,the rate of missed diagnosis,misdiagnosis rate,and diagnosis rate of NBI in the diagnosis of early carcinoma and precancerous lesions were 85%,89.13%,15%,10.87%and74.13%,respectively.Sensitivity,specificity,the rate of missed diagnosis,misdiagnosis rate,and diagnosis rate of Iodine staining in the diagnosis of early carcinoma and precancerous lesions were 80%,91.3%,20%,0.87%and71.3%,respectively.NBI technology and Iodine staining for the diagnosis of early Hypopharyngeal and Esophageal carcinoma or precancerous lesions were better than thant of conventional white light endoscopy.(b)When diagnosed by pathology,there were 19 lesions belonged to grade I,9 lesions belonged to grade II of NBI in the early carcinoma,10 lesions belonged to grade II of NBI in the low grade intraepithelial neoplasiearly carcinomaa,40 lesions fallen in grade III of NBI in inflammation and ectopic gastric mucosa.When diagnosed by pathology,there were 14 lesions belonged to grade I,10 lesions belonged to grade II of iodine staining in the early carcinoma,12 lesions belonged to grade II of iodine staining in the low grade intraepithelial neoplasiearly carcinomaa,42 lesions fallen in grade III of iodine staining in inflammation and ectopic gastric mucosa.The Kappa conformance test was taken:the consistent of classification by NBI,iodine staining and pathological diagnosis was good(K = 0.684,0.662).(c)Patients with esophageal cancer had 6 sites of repeated carcinoma,including 4 sites of hypopharyngeal cancer and 2 sites of gastric cancer.Besides,3 cases of esophageal cancer with multiple sites of lesions were identified as well.(d)7patients complained of pharyngeal pain after iodine staining test of the esophagus at the neck level,there was also 1 case of voice hoarseness.Conclusion:(a)NBI mode endoscopy diagnosis hypopharynx and early esophageal squamous cell carcinoma and precancerous lesions is superior to ordinary white light endoscopy.(b)NBI grade and iodine staining,are similar to pathological diagnosis classifacatian of esophageal squamous cell carcinoma and precancerous.(c)Hypopharynx inspection is also important in gastroscopy.