Value Of Magnifying Endoscopy And Endoscopic Ultrasonography In Preoperative Diagnosis Of Early Esophageal Carcinoma

Objective: The main purpose of this study was to discuss the diagnostic value of the Magnifying endoscopy(ME)and Endoscopic ultrasonography(EUS)for the preoperative diagnosis of Early esophageal cancer(EEC)and judge the invasion depth in our hospital,and to analyze the relevant factors that might affect the diagnostic accuracy.Methods: To collect clinical data of patients who were preliminarily considered as EEC by ME and EUS examination and received Endoscopic submucosal dissection(ESD)in our hospital from January 2017 to December 2020,including age,gender,pathological classification,tumor diameter,mucosal erosion lesions,concave focal lesions,tumor location,endoscopic classification,type B2 vessels,type of ultrasonic probe,ME invasion depth,EUS invasion depth,pathological invasion depth,etc.The consistency between ME and pathological results and between EUS and pathological results were compared respectively with reference to postoperative pathological results as the gold standard for evaluation.The chi-square test and binary Logistic regression were used to analyze the relevant factors affecting the diagnostic accuracy.Results:(1)A total of 126 patients with EEC were included in the analysis of the diagnostic accuracy of ME and EUS for EEC.The overall accuracy,sensitivity and positive predictive value of ME for EEC were 83.3%(105/126),100%(105/105)and83.3%(105/126)respectively.The overall accuracy,sensitivity and positive predictive value of EUS for EEC were 83.3%(105/126),96.2%(101/105)and 85.6%(101/118)respectively.(2)A total of 105 patients with EEC were included in the ME diagnostic analysis of the invasion depth of EEC,the overall accuracy of ME in the diagnosis of EEC invasion depth was 62.9%(66/105),the sensitivity,specificity,positive predictive value and negative predictive value of ME for superficial mucosal(M1/M2)lesions were 68.8%(55/80),56.0%(14/25),83.3%(55/66)and 35.9%(14/39)respectively.The Yoden index is 0.248 and the Kappa value is 0.178.Univariate correlation analysis suggested that in the process of ME judging the invasion depth of EEC,type B2 vessels would have an impact on the diagnostic accuracy.(3)A total of101 patients with EEC were included in the EUS diagnostic analysis of the invasion depth of EEC,the overall accuracy of EUS in the diagnosis of EEC invasion depth was 53.5%(54/101),the sensitivity,specificity,positive predictive value and negative predictive value of EUS for the diagnosis of superficial mucosal lesions(M1/M2)were 51.3%(39/76),80.0%(20/25),88.6%(39/44)and 35.1%(20/57)respectively.The Yoden index is 0.313 and the Kappa value is 0.229.Univariate correlation analysis indicated that the type of ultrasonic probe,tumor diameter,depression lesions and mucosal erosion lesions were significantly correlated with the diagnostic accuracy of EUS in EEC invasion depth(P < 0.05).Further multivariate correlation analysis suggested that tumor diameter and mucosal erosion lesions could independently affect the diagnostic accuracy of EUS in EEC invasion depth.Conclusion:(1)Both ME and EUS have certain diagnostic reference value for the judgment of EEC invasion depth.(2)Type B2 vessels are related factors affecting the diagnostic accuracy of ME in EEC invasion depth,and the diagnostic accuracy of lesions containing type B2 vessels is significantly reduced.(3)For lesions with a diameter of < 20 mm and accompanied by mucosal erosion lesions,the diagnostic accuracy may be reduced.(4)In the diagnosis of invasion depth of EEC,it is suggested to combine ME and EUS to obtain a higher diagnostic accuracy.