The Value Of Combined Ultrasound,Narrow-band Imaging-magnifying Endoscopy And CT In Preoperative Assessment Of Early Stage Upper Gastrointestinal Cancer

Objective To explore the clinical value of combined assessment of early endoscopic treatment of upper gastrointestinal tract by endoscopic ultrasonography combined with narrow-band imaging plus endoscopic and CT examination and postoperative pathological results.Methods From April 2015 to May 2017,the white light endoscopy found esophagus,gastric mucosal erosion,rough color changes and other suspicious lesions,and biopsy pathology prompted early upper gastrointestinal cancer and precancerous lesions Of patients,signed informed consent,has completed the ultrasound gastroscopy,narrowband imaging combined with magnifying gastroscopy and CT examination,all the test results by the Anhui Provincial Hospital Department of Gastroenterology to determine the stage of the discussion,and after consultation with patients and their families Determine endoscopic treatment or into surgery.Ultrasound endoscopy,narrow-band imaging plus magnifying endoscopy,CT examination results and postoperative pathology,analysis of integrated endoscopic ultrasonography,narrow-band imaging and magnifying endoscopy,CT examination to assess the value.Results 1.esophageal disease results1.1 Esophageal cases of 84 cases,80 cases of endoscopic resection,complete resection in 69 cases(86.3%),surgery in 4 cases,postoperative pathological level margin,the vertical cut edge were negative,the comprehensive evaluation accuracy(79.8%),NBI-ME(79.8%)and CT(22.6%)were significantly higher than those of CT(P <0.05).Postoperative pathology showed that the positive rate of vertical margin was 0,the comprehensive evaluation of the depth of the lesion to determine the accuracy of 100%,higher than the EUS,NBI-ME single discriminant.Postoperative pathology showed that 13.1% of the patients had positive horizontal margin.The accuracy of white light gastroscopy combined with NBI-ME in determining the extent of lesions was 86.9%.1.2 The sensitivity of common white light endoscopy and biopsy pathology diagnosis of esophageal cancer was 87.5%,the specificity was 50.0%,and the accuracy rate was 85.7%.NBI-ME had a sensitivity of 50.0%,a specificity of 87.5%,and an accuracy of 85.7% for judging non-cancerous lesions,a sensitivity of 94.5%,a specificity of 45.5%,and an accuracy of 81.0% for lesions confined to the mucosa and SM1,and judging lesions.The sensitivity of infiltration to SM2 and above was 71.4%,the specificity was 94.8%,and the accuracy rate was 93.6%.EUS judgment was limited to the sensitivity of the mucosal lesions with a sensitivity of 84.5%,a specificity of 77.0%,and an accuracy of 83.3%;the sensitivity of infringement to submucosal lesions was 66.7%,the specificity was 78.2%,and the accuracy was 83.3%.The sensitivity of muscle layer and below is 85.7%,specificity is 80.5%,and accuracy is 92.9%.The sensitivity of CT to early esophageal cancer was 67.1%,the specificity was 72.7%,and the accuracy rate was 26.2%.2.Stomach lesion results 2.1 The total number of gastric cases were 98 cases.The complete resection was performed in 86 cases and the accuracy of the combined assessment was 93.9%.The accuracy of comprehensive evaluation was higher than that of EUS(69.4%),NBI-ME(88.8%),CT(44.9% Single discriminant,significantly higher than CT.The accuracy of EUS in determining the depth of lesion was higher than that of CT(P <0.05).The accuracy of CT in predicting lymph node metastasis was significantly higher than that of EUS(P = 0.025).NBI-ME diagnosis of early gastric cancer lesions than conventional gastroscopy biopsy pathology was significantly higher(P = 0.001).The accuracy of NBI-ME in judging the lesion range was higher than that of ordinary gastroscopy,and the accuracy of NBI-ME was significantly improved between 2 cm and 3 cm(P = 0.05).2.2 The diagnostic accuracy of plain white light endoscopy and biopsy pathology was 69.4%.The sensitivity of high-grade neoplastic and intramucosal cancer was 75.0 %,the specificity was 70.0%,and the accuracy rate was 72.7%.NBI-ME judged the sensitivity of early-stage gastric cancer was 93.2%,specificity was 80.0%,and accuracy was 90.9%.The sensitivity of EUS was confined to mucosal lesions with a sensitivity of 89.7%,a specificity of 72.7%,and an accuracy of 89.7%.The sensitivity of infringement to submucosal lesions was judged to be 75.0%,the specificity was 87.8%,and the accuracy was 75.0%.The diagnostic accuracy of CT was 44.9%.The sensitivity of early gastric cancer was 55.7%,the specificity was 60.0%,and the accuracy rate was 45.8%.3.Misjudgment resultsWhite light endoscopy and biopsy pathology are likely to result in underestimation,especially in the lower esophagus,cardia,gastric antrum;misdiagnosis between the esophagus and stomach is not significant.There is no significant difference in the likelihood that EUS will overestimate or underestimate.The miscarriage rate in the lower esophagus,the angle of the stomach,and the fontanelle are higher.Joint assessment is more likely to misjudge 0-IIb lesions.Conclusions The preoperative evaluation of early cancer and precancerous lesions in upper digestive tract is more accurate and reliable by combining endoscopic ultrasonography,CT and narrow band imaging with endoscopy,especially for assessing the depth of invasion of early cancers and precancerous lesions in the upper digestive tract,The evaluation is accurate and reliable.