| BackgroundEsophageal cancer is common in clinical,which usually has developed to the advanced stagewhen the patient has symptoms,the people who is diagnosed with the advanced cancer survive shorter that 5-year survival rate is less than 20%,while early diagnosis of esophageal cancer can make the patientcured using endoscopical therapy,which achieves the same curative ratio with surgery that not only 5-year survival rate reaches up to 95% or more,but alsothe patient undergoes less pain,trauma and hospital stay is short,which can get a better economic efficiency,Early detection,diagnosis and treatment are of great significance.With the continuous development of endoscopic minimally invasive technology,endoscopic NBI and iodine staining diagnostic technology are maturing,which is important to improve early detection and diagnostic rate of esophageal cancer and precancerous lesions that not only improving the prognosis of patients andreducing the burden on the family,but also saving the national resources and reducing the social burden.ObjectiveThrough the comparison of NBI and iodine staining on the detection rate of early esophageal cancer and precancerous lesions,definiting the best way of improving the diagnosis rate of early esophageal and precancerous lesions.MethodsSelecting the patients for 86 who came to our hospital for endoscopy with NBI,iodine stainingand pathological examination and were diagnosed esophageal lesions from August 2015 to January 2017,comparing the patient’s general endoscopy,NBI and iodine staining characteristics with the pathological results,understanding the sensitivity and specific differenceson the early diagnosis of different types of esophageal cancer and precancerous lesions among the conventional endoscopy,NBI and iodine staining.Results 1.General information86 cases who were diagnosed with chronic inflammation for 14 cases,mild dysplasia for 18 cases,moderate dysplasia for 4 cases,severe dysplasia for 7 cases,early esophageal cancer for 43 cases.There were 24 males and 19 females,aged 32-83 years,mean age 60.3±10.46 years old in the patients who were diagnosed with early esophageal cancer.2.Clinical manifestationsAmong the patients with early esophageal cancer,39.5% were underweight,25.6% were esophageal foreign bodies,20.9% were anti-acid and 14.0% were family history of esophageal cancer.The weight loss was found in patients with chronic inflammation of esophagus accounting for 7.1%,esophageal foreign bodies accounting for 14.3%,anti-acid accounting for 64.3%,with esophageal cancer family history accounting for 14.3%;diagnosed as mild,moderate and severe dysplasia patients,weight loss accounting for 24.1%,foreign bodies sensation accounting for 13.8%,anti-acid accounting for 44.8%,with esophageal cancer family history accounting for 17.2%.3.The situation of early esophageal cancer and precancerous lesions by routine endoscopy,NBI,iodine stainingThe sensitivity of conventional endoscopy to early esophageal cancer and precancerous lesions was 52.7%,specificity was 35.7%,positive predictive value was 80.9% and negative predictive value was 12.8%.The sensitivity of NBI to early esophageal cancer and precancerous lesionswas 86.1%,the specificity was 85.7%,the positive predictive value was 96.8% and the negative predictive value was 54.5%.The sensitivity of iodine staining to early esophageal and precancerous lesions was 91.6%,The specificity was 92.9%,the positive predictive value was 98.5%,and the negative predictive value was 68.4%.4.The situation of the cases of different lesions by routine endoscopy,NBI,iodine staining2 cases were found in the upper esophageal lesions,32 cases were found in the middle esophageal lesion and 13 cases in the lower esophageal lesions by conventional endoscopy.There were 5 cases of upper esophageal lesions,40 cases of middle esophageal lesions and 19 cases of lower esophageal lesions by NBI.the upper esophageal lesions detected in 0 cases,44 cases of middle esophageal lesions,lower esophageal lesions detected in 23 cases by iodine staining.5.Situation of esophageal lesions grading by different endoscopic observationAmong the people diagnosed with high-gradeintraepithelial neoplasia,NBI I grade 82%,iodine staining I grade 88%,there was no significant difference between the two groups(P> 0.05),IPCL IV and V type 90% according to IPCL genotype,and among the people diagnosed with low-gradeintraepithelial neoplasia,NBI I grade 9.1%,II,III 50.0%,negative 40.9%,that is,NBI classification of LGINhas lower specificity,while iodine staining I grade 4.5%,II,III 68.2% Negative 27.3%,which is mainly manifested as iodine staining II,III grade,IPCL II,III type 86.4% according to IPCL genotype,that is,IPCL morphological classification was related to pathological diagnosis.6.TreatmentThe treatment of early esophageal cancer was mainly applying ESD,ESD-based treatment accounted for 61.1%;the lesions which was in the upper esophagus,or less than 2cm and only limited to the mucosal were treated using EMR,EMR-based treatment accounted for 33.3%;when ESD or EMR treatment were contraindicated to use,surgery or radiotherapy and chemotherapy treatment were selected,which accounted for 5.6%.7.ComplicationEndoscopic treatment of early esophageal cancer and precancerous lesions prone to bleeding,perforation and postoperative esophageal stenosis and other complications.In this group of 72 cases of endoscopic treatment cases,bleeding in 3 cases whose bleeding had been stopped by endoscopy,perforation in 0 cases.With the reason of a large range of resection,postoperative esophageal stenosis in 13 cases,but there is no impact on eating,no special treatment.Conclusions1.NBI and iodine staining in the early esophageal cancer and precancerous lesions have a higher detection rate,the combination of them can further improve the early esophageal cancer and precancerous lesions detection rate;2.NBI combining with endoscopic observation of IPCL morphology can further determine the severity of the disease andis the base of the choice of treatment and judgement of prognosis;3.Endoscopic treatment of early esophageal cancer and precancerous lesions with good results,fewer complications is significanceto improve the prognosis. |
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