Preliminaryanalysis Of Early Diagnosis And Treatment Of Upper Gastrointestinal Cancer In Guangxi And Clinical Application Of ME-NBI In Screening

Objective Based on the data of endoscopy screening project for early diagnosis and treatment of upper gastrointestinal cancer in Guangxi Medical University Affiliated Tumor Hospital(A Center)and Qinzhou First People's Hospital(B Center),to analysis the distribution ratio,detection rate and early diagnosis rate of upper gastrointestinal cancer and precancerous lesions in two centers of Guangxi,and evaluate the current situation of upper gastrointestinal cancer screening in our region,and discuss the technology of magnifying endoscopy combined with narrowband imaging.The clinical application value of magnifying endoscopy combined with narrow-band imaging(ME-NBI)in early cancer screening provides scientific basis for the optimization of early diagnosis and treatment of upper gastrointestinal cancer in our region.Method Taking the local residents who participated in the project of early diagnosis and treatment of upper gastrointestinal cancer in Guangxi A andB centers in 2016 and 2017 as the research objects,we based on the national technical scheme of early diagnosis and treatment of cancer,the screening population was examined by gastroesophageal endoscopy and biopsy,and gastroesophageal endoscopy and biopsy were performed on the screening population.To analysis of the results of pathological diagnosis of screening biopsy specimens,and compare the detection of gender,age,annual and regional distribution of upper gastrointestinal cancer and precancerous lesions,and early esophageal cancer and gastric cancer diagnostic rate of A,B centre.Analysis of 118 upper gastrointestinal mucosal lesions(including 60 screening populations)by WLE and ME-NBI in Guangxi A and B endoscopy centers in 2018,including 39 esophageal mucosal lesions(50 lesions),and 79 gastric mucosal lesions(94 lesions).The diagnostic criteria of endoscopic lesions were AB classification and VS classification,respectively.Biopsy histopathology was the gold standard.To evaluate the diagnostic value of WLE and ME-NBI for malignant lesions,respectively.Results In 2016 and 2017,2399 local residents were screened by endoscopy in Centers A and B.A total of 275 cases of esophageal lesions were detected.2 cases were invasive esophageal cancer(0.73%),1 case were early esophageal cancer(0.36%),17 cases were low grade intraepithelial neoplasia(6.18%),and 255 cases were normal or esophagitis(92.73%).2101 cases of gastric lesions.8 cases were invasive gastric cancer(0.38%),4 cases were early gastric cancer(0.19%),11 cases were high-grade intraepithelial neoplasia(0.52%),445 cases were low-grade intraepithelial neoplasia(21.18%),554 cases were atrophic gastritis(26.37%)and 1079 cases were normal or non-atrophic gastritis(51.36%).In upper gastrointestinal cancer and precancerous lesions,the detection rate of male was higher than that of female,and gradually increased with age and year,the difference was significant with age(P < 0.05).The detection rate and regional distribution of gastric cancer and precancerous lesions were different(P < 0.05).In A center,no esophageal cancer was found during screening,and the early diagnosis rate was not assessable.While the early diagnosis rate of gastric cancer was 100%(5/5).In B center,the early diagnosis rate of esophageal cancer City was 33.33%(1/3),and the early diagnosis rate of gastric cancer was55.56%(10/18).Of the 39 patients with esophageal mucosal lesions(50 lesions),the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ME-NBI in the diagnosis of esophageal cancer by AB classification were 95%,76.7%,73.1%,95.8%,84%,respectively.Compared with WLE,ME-NBI increased the specificityand accuracy of esophageal neoplastic lesions(76.7% vs 30%,84% vs 46%,P all <0.05).Of the 79 patients with gastric mucosal lesions(94 lesions),the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ME-NBI in the diagnosis of gastric cancer by VS classification were 92.3%,86.4%,52.2%,98.6%,and 87.2%,respectively.Compared with WLE,it can be concluded that the specificity and accuracy of ME-NBI technique for the diagnosis of gastric tumor lesions are increased(86.4% vs 72.8%,87.2% vs73.4%,P all<0.05).60 cases of screening were examined by ME-NBI.Two cases of esophageal high-grade intraepithelial neoplasia and three cases of gastric high-grade intraepithelial neoplasia were detected by ME-NBI.The early diagnosis rate of upper gastrointestinal cancer were 100%.Compared with the early diagnosis rate of upper gastrointestinal cancer in 2016 and 2017,the early diagnosis rate of suspected upper gastrointestinal cancers by ME-NBI in 2018 increased,but no difference between 2016,2017 and 2018(P>0.05).Conclusions The implementation of the early diagnosis and treatment of upper gastrointestinal cancer can effectively screen upper gastrointestinal cancer and precancerous lesions in high-risk populations in Guangxi,thus further improving the early diagnosis rate of upper gastrointestinal cancer.Further ME-NBI examination can significantly improve the diagnostic accuracy of suspected upper gastrointestinal mucosal lesions combinated with WLE.