| Obective To investigate whether chromoendoscopy combining with examination of telomerase activity and DNA ploidy could increase the early diagnostic rate or reduce the pseudonegative and pseudopositive diagnostic rate of early esophageal carcinoma, and to establish practical methods.Methods Tumor-adjacent mucosa of 47 cases of esophageal carcinoma and esophageal mucosa of 1136 cases of highly dangerous people of esophageal carcinoma were dyed by Rhogol solution-methylence blue orthopticly in electric endoscopy , and the lesion founded was biopsied with pathologic detection and DNA ploidy examination by flow cell metrics and quality and quantity detection of telomerase activity by TRAP-PCR-PAGE and TRAP-PCR-ELISA.Results â‘ One hundred and twenty eight places of lesion in 123 cases founded in 1136 cases of high dangerous people of esophageal carcinoma in conventional electric endoscopy. The lesion finding rate was 11.26% (128/1136). The range of lesion was more clear after dyed, and 30 places of lesion were newly found. The pathologic diagnosis of the 123 cases of patients founded by conventional electric endoscopy were as follows: 64 cases of esophagitis, 2 cases of simply hyperplasia, and 6 cases of light dysplasia (6 places), 17 cases of moderate dysplasia (20 places), and 12 cases of severe dysplasia (21 places, among which 7 places found after dyed),22 cases of squamous cell carcinoma (37 places, among which 13 places found after dyed); for the negative cases in conventional electric endoscopy 74 cases founded with lesion in chromoendoscopy, and the pathologic diagnosis of these patients were as follows: 43 cases of esophagitis, 4 cases of simply hyperplasia, and 5 cases of light dysplasia (7 places), 8 cases of moderate dysplasia (10 places), and 6 cases of severe dysplasia (9 places), 8 cases of squamous cell carcinoma (10 places). New lesion finding rate was 9.85%(112/1136). Chromoendoscopy could increase esophageal lesion finding rate significantly: the new lesion finding rate of dysplasia and squamous cell carcinomawere increased after chromoendoscopy was used from 2.99% (34/1136) to 4.23% (48/1136). (2) The positive rate of telomerase activity of dysplsia and squamous cell carcinoma (80.82%, 95.7%) were significantly higher than that of esophagitis and simple hyperplasia (1.86%, 0%)(P<0.001), but there was no significant difference between that of moderate and severe dysplasia and squamous cell carcinoma (P>0.05). And the positive rate of telomerase activity increased as severity of dysplasia increased (46.15%, 83.33%, 93.33%). The sensitivity and specificity of differential diagnosis of dysplasia and squamous cell carcinoma between esophagitis and simple hyperplasia by telomerase activity examination were 81.11% (73/90) and 98.23% (111/113%) respectively. (3) The sensitivity and specificity of differential diagnosis of dysplasia and squamous cell carcinoma esophagitis and simple hyperplasia by DNA ploidy examination were 76.62% (59/77) and 98.23% (111/113%) respectively. ? In esophageal diseases, 72.91% (35/48) of moderate to severe dysplasia and squamous cell carcinoma was both positive in telomerase activity and DNA ploidy examination, but 0.00% (0/113) of esophagitis and simple hyperplasia was both positive. Combining examination of telomerase activity and DNA ploidy had more sensitivity (100%, 48/48) and specificity (100%, 113/113) in differential diagnosis of dysplasia and squamous cell carcinoma esophagitis and simple hyperplasia than singly examination (p<0.01). This result was similar to that in differential diagnosis of 47 cases of tumor-adjacent tissue (dyed area compared with undyed area).Conclusion Screening of high dangerous people with chromoendoscopy following biopsy, pathologic detection and telomerase activity and DNA ploidy examination could increase diagnostic rate of early esophageal carcinoma, and got substantial early diagnosis of esophageal carcinoma, and had clinic directional significance in treatment of moderate to severe dysplasia. |
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