| BackgroundEsophageal cancer EC is a malignant tumor that originates from the esophageal mucosa and is one of the common clinical malignancies.It commonly occurs in middle-aged and elderly men.Because the early symptoms of esophageal cancer are often atypical,the main symptoms being similar to benign lesions such as reflux esophagitis,and the symptoms are mild and severe,which is not easy to cause patients to pay attention to.More than 90%of patients with esophageal cancer have progressed to mid-and advanced stages when they are diagnosed.At this time,patients often require large radical esophageal surgery,and complications are severe in following days.Some patients even lose the chance of surgery.The prognosis is poor.Most patients die of late cachexia.The quality of life is very poor,and the clinical treatment effect is not good.Research shows that the overall 5-year survival rate is less than 20%under comprehensive treatment.It is reported that the 5-year survival rate of early esophageal squamous cell carcinoma after surgical resection is 85%-90%,while the 5-year survival rate for advanced-stage patients is only 6%-15%.However,early esophageal cancer involving only the mucosal layer can usually be treated radically with minimally invasive endoscopy,and has the same effect as surgery,which has the advantages of less trauma,less pain,and faster recovery.The 5-year survival rate of patients can exceed 95%.Therefore,improving the detection rate and diagnosis rate of early lesions of esophageal cancer is the key to the entire treatment process of esophageal cancer,which has great clinical significance for the follow-up treatment,prognosis,and reduction of family economic burden.In recent years,the development of endoscopic technology has improved the diagnosis of early esophageal cancer.However,there are few studies on I-Scan technology for early esophageal cancer.This is a prospective study to explore the value of I-Scan combined with magnifying endoscopy in the diagnosis of early esophageal cancer and precancerous lesions.PurposeThe purpose of this study was to evaluate the diagnostic value of I-Scan endoscope in early esophageal cancer and precancerous lesions through comparing the examination of early esophageal cancer and precancerous lesions under the electron-stained endoscope I-Scan,iodine staining,and high-resolution white light endoscope,and the real-time diagnosis and pathological results of the combined endoscopic endoscopy with I-Scan.Methods1.Subjects:According to the inclusion and exclusion criteria,Patients with cancer and precancerous lesions,the esophageal mucosa morphology,color,and blood vessel texture being changed during endoscopic examination at the Endoscopic Center of the First Affiliated Hospital of Henan University from December 2017 to December 2019 were collected.2.Data Collection:Count and record patient's age,gender,smoking and drinking history and other general conditions and detailed medical history,record the location,number,morphology of lesions respectively under white light endoscope,I-Scan mode,and iodine staining,and I-Scan combination IPCL typing under magnifying endoscope3.Statistical Method:Perform statistical analysis with SPSS24.0 analysis software on the data collected in the study.In the measurement data,data that conforms to a normal distribution is expressed by the mean±standard deviation(x±s);the count data is expressed by the number of cases(n)and percentage(%).Counting data were tested by using x2.Kappa test was used for the consistency of real-time diagnosis and pathological results of IPCL typing under I-Scan combined magnifying endoscopy,with a value between 0 and 1.Kappa?0.75 has better consistency.0.75>Kappa?0.4 is general;Kappa<0.4 is poor.P<0.05 was considered statistically significant.Results(1)A total of 80 eligible patients were included in this study from December 2017 to December 2019.A total of 92 lesions were founded under 3 endoscopic modes.The detection rates of white light endoscopy,I-Scan and iodine staining in early esophageal cancer and precancerous lesions were 56.25%(45/80),88.75%(71/80)and 92.50%(74/80).If the detection of Scan and iodine staining for early esophageal cancer and precancerous lesions was higher than that of white light endoscopy,it means the difference was statistically significant(x2=9.683,P=0.008);if the detection of I-Scan and iodine staining for early esophageal cancer and precancerous lesions is similar,it means the difference between the two is not statistically significant(P=0.682)(2)IPCL typing prediction was performed under I-Scan combined magnifying endoscopy in 73 esophageal lesions found in I-Scan mode,compared with pathological results showing that there were 26 IPCL typing A types,of which 1 early esophageal cancers,1 HGIN,22 LGIN,2 inflammations;22 IPCL types B1,pathological results showing 4 early esophageal cancers,12 HGIN,6 LGIN,23 IPCL types B2,and pathological results showing 16 early esophageal cancers,4 HGIN,3 LGIN.Early esophageal cancer and HGIN are mainly B1 and B2 types,with B1 and B2 types accounting for 94.7%;LGIN and inflammation are mainly type A,accounting for 72.7%.The results showed that the prediction of IPCL typing was generally consistent with the pathological results(Kappa=0.585)(3)Among the 73 positive lesions found in the I-Scan mode,based on the biopsy pathology,2 of which were inflamed,71 lesions of esophageal precancerous and precancerous lesions were removed.I-Scan combined with magnifying endoscopy was used to evaluate IPCL classification Infiltration depth,and compared with postoperative pathological results,a total of 52 lesions were correctly evaluated,and the overall coincidence rate was 73.2%.Among them,the accuracy of type A IPCL to evaluate the depth of invasion was 83.1%,and the accuracy of type B1 IPCL to evaluate the depth of invasion was 77.5%,the accuracy of B2 type IPCL in evaluating the depth of infiltration was 85.9%Conclusion(1)Electronic-stained endoscope I-Scan and iodine-stained endoscope have a higher detection rate in the examination of early esophageal cancer and precancerous lesions,which are significantly higher than those of white light endoscope.And the detection rate of electronic staining endoscope I-Scan is not inferior to that of Lugol's iodine staining endoscope(2)Electronic staining endoscopy I-Scan combined with magnifying endoscopy has high accuracy in real-time diagnosis of esophageal precancerous and precancerous lesions and assessment of the depth of infiltration through IPCL morphological classification,which is helpful for guiding the targeting of lesions under endoscopic Biopsy and can improve the diagnosis rate of early cancer and precancerous lesions,and has a certain reference significance for the choice of subsequent treatment methods and follow-up methods I-Scan combined with magnifying endoscopy has clinical value in the diagnosis of early esophageal cancer and precancerous lesions. |
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