The Value Of Narrow Band Imaging Zoom Magnification Endoscopy Combined With Micro-probe Endscopic Ultrasonography(MPS) In The Diagnosis And Treatment Of Early Esophageal Cancer And Precancerous Lesions

Objective:Objective: to evaluate the value of(narrow band imaging zoom magnification endoscopy)NBI-ME combined with micro-probe endscopic ultrasonography(MPS)in the prediction of early esophageal cancer or precancerous lesions and the guidance of treatment.Methods:A total of 91 cases of highly suspected early esophageal cancer or precancerous lesions admitted to our hospital from July 2014 to January 2020 who underwent endoscopic mucosal dissection(ESD)were collected.The specimens obtained after ESD surgery were all fixed with 10% formalin,vertically cut into 2-3mm thick slices,and then observed and classified under a microscope by experienced pathologists.SPSS22.0 statistical software was used for data analysis.With the postoperative complete histopathological results as the gold standard,the prediagnosis results of NBI and the pre-diagnosis of the depth of infiltration of the lesion with micro-probe endscopic ultrasonography were analyzed for consistency as well as the preoperative biopsy results,and calculation of Kappa value,which is a better consistency with acuity K for 0.61-0.80,0.41-0.60 for a medium consistency,0.21-0.40 for a general consistency,and 0-0.20 for an extremely low consistency,calculat their total accuracy,at the same time,to evaluate the effect of narrow band imaging zoom magnification endoscopy in the pre-diagnosis of esophageal early cancer or precancerous lesions,and to evaluate the application value of micro-probe endscopic ultrasonography(MPS)in determining the invasion depth of esophageal early cancer or precancerous lesions and guiding the selection of clinical treatment options.Results:1.After observation by NBI-ME,among the 91 patients,54 cases of high grade intraepithelial neoplasia(HGIN)were predicted by NBI-ME and diagnosed by postoperative pathology.There were 28 cases which the prediction result of NBI-ME and the postoperative pathological diagnosis were both early esophageal cancer.There were 1 cases which NBI-ME predicts low-grade intraepithelial neoplasia but postoperative pathological result is high-grade intraepithelial neoplasia;NBI-ME predicts high-grade intraepithelial neoplasia,but the postoperative pathology was 1 case of low-grade intraepithelial neoplasia and 5 cases of early cancer;NBI-ME predicts early cancer,but the postoperative pathology was 1 case of low-grade intraepithelial neoplasia and 1 case of high-grade intraepithelial neoplasia.Comparing NBI-ME with postoperative pathological diagnosis,the total accuracy rate is 90.11%,which can be considered as a good accuracy,and K = 0.792,which can be regarded as a good consistency.2.The consistency between preoperative biopsy pathology and postoperative complete pathology was acceptable(K = 0.645> 0.6).3.Among the 91 cases,76 cases were examined with micro-probe endscopic ultrasonography(MPS)before operation to determine the depth of infiltration.Micro-probe endscopic ultrasonography was preliminarily judged as 65 cases of mucosal layer(including 60 cases of postoperative pathological results of mucosa layerand and 5 cases of submucosal layer),Predicting 11 cases of infiltrating submucosa(including postoperative pathological results of 2 cases of lesion infiltrating mucosal layer and 9 cases of infiltrating submucosal layer),consistency analysis of micro-probe endscopic ultrasonography and postoperative pathological results: total accuracy rate is 90.79%,which can be considered as a good accuracy,K = 0.666,it can be considered that the consistency of the micro-probe endscopic ultrasonographyand the postoperative pathological results are average.Conclusion:Narrow-band imaging zoom magnification endoscopy can clearly display mucosal microstructure,by identifying the microstructure of different feed tube wall mucous membrane structure and the microvascular morphology change,can more accurately diagnosis of early esophageal cancer and precancerous lesions,coupled with micro-probe endscopic ultrasonography can better evaluate infiltration depth lesions,predict the risk of deep(submucosal layer)infiltration as well as indirect predict the risk of lymph node metastasis,combined with pathologic examination results and other technology at the same time,can do more accurate comprehensive assessment of disease condition,in order to set the best treatment strategy for patients.