Diagnostic Value Of Magnifying Endoscopic Narrow Band Imaging And Endoscopic Ultrasonography In The Early Esophageal Carcinoma And Precancerous Lesions

Background and objectiveMost of the early stage esophageal cancer and precancerous lesions can be cured under endoscopy.Magnifying endoscopy with narrow band imaging(ME-NBI)and endoscopic ultrasonography(EUS)can be used to assess the depth of the lesion before operation,but whether there is a difference in the accuracy of the assessment of MENBI and EUS is still controversial.Meanwhile,there are few researches on the joint assessment of lesion depth by ME-NBI and EUS.The purpose of this study is to explore the diagnostic value of ME-NBI,EUS and the combined examination of the two in the diagnosis of early esophageal carcinoma infiltration depth,and to explore the influencing factors of the accuracy of ME-NBI and EUS in assessing the depth of lesions.MethodsThis study collected patients who were initially diagnosed with early esophageal carcinoma or esophageal high-grade intraepithelial neoplasia(HGIN)at Nanfang hospital of Southern Medical University from January 2011 to December 2020.These patients have completed one of the following three endoscopies:LCE,ME-NBI,EUS,and have received endoscopic or surgical operations in our hospital.With postoperative of pathological diagnosis as the gold standard,this study mainly analyzes the diagnostic accuracy of preoperative ME-NBI and EUS in assessing the depth of the lesion,and comparing the value of ME-NBI,EUS,ME-NBI combined with EUS in assessing the depth of the lesion.Results1.A total of 295 patients(364 lesions)were enrolled in this study,including 182 males and 113 females,with an average age of 60.28±8.75 years.The clinical manifestation were mainly choking on swallowing,post-sternal pain(39.0%)and upper abdominal symptoms(31.2%).The lesions were more likely to occur in the middle esophagus(54.1%).The most common Paris classification of lesions was type 0-Ⅱb(79.7%).The treatment of lesions was mainly ESD(77.5%).The en-bloc resection rate under endoscopy was 93.8%,and the complete resection rate was 98.8%.The incidence of bleeding after endoscopic surgery was 0.4%,the incidence of intraoperative perforation was 6.5%,and the incidence of esophageal stenosis after endoscopic surgery was 17.2%.There were 11 lesions(3.0%)of pathological inflammation,59 lesions(16.2%)of low-grade intraepithelial neoplasia(LGIN),215 lesions(59.1%)of HGIN,41 lesions(11.3%)of mucosal carcinoma,35 lesions(9.6%)of submucosal carcinoma,3 lesions(0.8%)invaded the muscularis propria and deeper layer.The LCE staining grade of 257 lesions(80.1%)of HGIN and esophageal carcinoma was gradeⅣ.2.According to the ME-NBI assessment of 200 lesions,the accuracy of the diagnosis of the depth was 83.0%(166/200).The diagnostic accuracy of ME-NBI for epithelial layer/lamina propria(EP/LPM)lesions was 87.0%,and that for muscularis mucosa/superficial submucosa(MM/SM1)lesions was 88.0%.According to the EUS assessment of 247 lesions,the accuracy of the diagnosis of the depth was 79.8%(197/247).The diagnostic accuracy of EUS for mucosal lesions was 80.6%,and that for submucosal lesions was 83.4%.ME-NBI combined with EUS assessments were performed on 140 lesions at the same time,and the accuracy of the diagnosis of the depth was 90.7%(127/140).There was no statistically significant difference in diagnostic accuracy between ME-NBI and EUS(P=0.383).The diagnostic accuracy of ME-NBI combined with EUS was higher than that of ME-NBI or EUS alone,and the difference was statistically significant(P=0.043;P=0.005).The influencing factor of the accuracy of EUS in evaluating the depth of lesions was the shape of the lesions(P=0.002).Conclusions1.ME-NBI and EUS can better assess the depth of early esophageal carcinoma and precancerous lesions,and there is no significant difference in the diagnostic accuracy of the two.2.The diagnostic accuracy rate of ME-NBI combined with EUS examination is significantly higher than that of simple ME-NBI examination or simple EUS examination,suggesting that the combined examination of the two before operation has clinical significance.3.The shape of the lesion may be an influencing factor for the accuracy of EUS examination.4.Endoscopic resection of early esophageal carcinoma and precancerous lesions is an effective and safe treatment.