The Accuracy Of Endoscopic And Pathological Diagnosis Of Early Cardiac Cancer And Precancerous Lesions Before Endoscopic Submucosal Dissection(ESD)

Objective: To evaluate the accuracy of white light endoscopy,magnifying endoscopy and endoscopic ultrasonography combined with pathology in diagnosing early cardiac cancer and precancerous lesions before endoscopic submucosal dissection(ESD).Methods: A total of 113 patients who received white light endoscopy(WLE),endoscopic ultrasonography(EUS),magnifying endoscopy(ME)and other digestive endoscopy techniques combined with endoscopic biopsy(EFB)in the department of gastroenterology of our hospital from January 2015 to June 2019,and diagnosed as cardiac intraepithelial neoplasia(CIEN)or early cardiac cancer(ECC)by endoscopic biopsy were analyzed,including 25 cases of low-grade intraepithelial neoplasia(LGIN),72 cases of high-grade intraepithelial neoplasia(HGIN),16 cases of early cardiac cancer(ECC).All patients underwent ESD.The pathological results were used as golden standard.Through the agreement(Kappa)test to evaluate the accuracy of white light endoscopy,endoscopic ultrasonography,magnifying endoscopy to separate or different combinations in diagnosing the nature and depth of the cardiac mucosal lesions before ESD,to evaluate the consistency between the diagnosis of early cardia cancer and precancerous lesions by various digestive endoscopy techniques before ESD and the pathological diagnosis after ESD.Results: 1.All patients underwent ESD,with ESD operation time(108±57)min,and the success rate of surgery was 100%.There was a small amount of bleeding during ESD operation,with an average bleeding volume of(24±6)ml.Two cases of intraoperative perforation and APC cauterization were used for hemostasis.All the cases had no major bleeding after operation and hemostasis under secondary endoscope.The maximum diameter of the lesion removed by ESD was(4.4±1.6)cm,with a total resection rate of 100% and a complete resection rate of 93.8%.2.The accuracy of EFB in 113 patients was 46.9%,including 36.0%,45.8% and 68.8% in LGIN groups,HGIN groups,and ECC groups.Kappa value was 0.175.The underestimation rate of EFB was 48.5% in cardiac intraepithelial neoplasia.3.The accuracy of EUS in 113 patients was 73.5%,including 95% and 21.2% in intramucosal lesions and submucosal lesions.Kappa value was 0.202.4.The accuracy of ME in 113 patients was 64.6%,including 81.1% and 56.6% in noncancerous lesions and cancerous lesions.Kappa value was 0.319.5.The accuracy of EUS+ME in 113 patients was 55.8%,including 81.1%,53.1% and 25.9% in IEN groups,intramucosal cancer groups(T1M)and submucosal cancer groups(T1SM).Kappa value was 0.313.The overestimation rate of EUS+ME was 55.3% in early cardiac cancer.Conclusions: There were a total of 113 patients with ECC or CIEN in this study,the accuracy of EFB in 113 patients was only 46.9%,and the diagnostic reliability was poor.Single EUS and ME had their own limitations,but the accuracy of combined EUS and ME was 55.8%,higher than that of EFB.We can use EUS combined with ME to improve diagnosis.However,in general,the accuracy of ESD preoperative diagnosis of cardiac neoplastic lesions by various digestive endoscopy is still not high,which is easy to be underestimated(diagnosis is insufficient).Therefore,preoperative judgment of ESD surgical indication and surgical plan should be cautious.