Retrospective Analysis And Accuracy Study In Different Experience Physicians Of M-NBI Combined With Endoscopic Utrasonography In Estimating The Invasion Depth Of Early Esophageal Cancer

Objective: To retrospectively analyze the diagnostic accuracy of Magnifying endoscopy with Narrow Band Imaging(M-NBI)and endoscopic ultrasonography(EUS),to discuss the coincidence of combined diagnosis and pathological results,and exploring the diagnostic accuracy of different diagnostic paths in different experienced physicians.Methods: This study selected patients with early esophageal cancer who had complete pathological data,M-NBI data and EUS data from the digestive endoscopy center of the LanZhou University Second Hospital from January 2013 to December 2018.The pathological diagnosis of the subjects was taken as the gold standard,and the preoperative diagnostic accuracy of M-NBI and EUS was analyzed respectively.Furthermore,the diagnosis results of the two,that exist same diagnosis or different diagnosis,were combined to analyze the consistency between pathological diagnosis.In addition,six endoscopists with different experiences were divided into the senior group,the middle group and the junior group.The representative images of each patient were sent to endoscopists with different experiences from the database for judgment,so as to study the diagnostic accuracy of different experienced physicians in M-NBI and EUS.Results: A total of 89 patients with esophageal cancer(95 lesions),with a median age of 62 years,71 males and 24 females.81 cases(85.3%,81/95)of M1-M2 stage cancer,13 cases(13.7%,13/95)of M3-SM1 stage cancer,and 1 case(1.0%,1/95)of SM2-SM3 stage cancer.The morphological manifestations were mainly type IIb(56.8%,54/95).All pathological types of lesions were squamous cell carcinoma.The overall accuracy of M-NBI was 90.5%,The kappa is 0.609,and the diagnostic sensitivity and specificity for M1-M2 cancer were 93.8% and 71.4%,respectively.The diagnostic sensitivity and specificity for M3-SM1 cancer were 69.2% and 94.0%,respectively.The overall accuracy of EUS was 77.5%,The kappa is 0.469,and the sensitivity and specificity for M1-M2 cancer were 76.5% and 85.7%,respectively.The diagnostic sensitivity and specificity for M3-SM1 cancer were 84.6% and 76.8%,respectively.When both were indicated with the same result,The accuracy is 93.7%.When MBI indicated M1-M2 cancer and EUS indicated M3-SM1 cancer,12 cases were M1-M2 cancer and 1 case was M3-SM1 cancer.When MBI indicated M3-SM1 carcinoma and EUS indicated M1-M2 carcinoma,all 3 cases were M1-M2 carcinoma.The expert group has the best diagnosis accuracy of 90.5% in M-NBI,the mid level junior groups and the junior group were 88.4% and 84.2%,respectively.The experienced physicians has the best diagnosis with an accuracy of 82.1% in EUS,the mid level group and the junior group were 76.8% and 66.3%,respectively.Conclusion: M-NBI and EUS have a good diagnostic performance in judging the infiltration depth of EEC,and the combination of M-NBI and EUS improves the diagnostic accuracy.Different experience physicians have different diagnoses for M-NBI?EUS and combined diagnosis,and primary physicians have low diagnosis accuracy for EUS.EUS is difficult for primary physicians.It is recommended to use the combination of M-NBI and EUS in clinical practice.