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首页> 外文期刊>Diseases of the esophagus: official journal of the International Society for Diseases of the Esophagus >Prospective evaluation of narrow-band imaging endoscopy for screening of esophageal squamous mucosal high-grade neoplasia in experienced and less experienced endoscopists
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Prospective evaluation of narrow-band imaging endoscopy for screening of esophageal squamous mucosal high-grade neoplasia in experienced and less experienced endoscopists

机译：对有经验和经验不足的内镜医师进行窄带成像内镜检查以筛查食管鳞状上皮高度瘤形成的前瞻性评估

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摘要

Narrow-band imaging (NBI) is a novel, noninvasive optical technique that uses reflected light to visualize the organ surface. However, few prospective studies that examine the efficacy of NBI screening for esophageal cancer have been reported. To compare the diagnostic yield of NBI endoscopy for screening of squamous mucosal high-grade neoplasia of the esophagus between experienced and less experienced endoscopists. Patients with a history of esophageal neoplasia or head and neck cancer received NBI endoscopic screening for esophageal neoplasia followed by chromoendoscopy using iodine staining. Biopsy specimens were taken from iodine-unstained lesions and the histological results of mucosal high-grade neoplasias served as the reference standard. The primary outcome was the sensitivity of NBI for detecting new lesions. The secondary outcome was the positive predictive value of NBI and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of NBI in a per lesion basis. A total of 350 patients (170 by experienced endoscopists and 180 by less experienced endoscopists) underwent endoscopic examination. A total of 42 new mucosal high-grade neoplastic lesions (25 in the experienced endoscopist group and 17 in the less experienced endoscopist group) were detected. In the per-lesion-based analysis, the sensitivity was significantly higher in the experienced endoscopist group (100%; 25/25) compared with the less experienced endoscopist group (53%; 9/17) (P < 0.001). The positive predictive value of NBI was higher in the experienced endoscopist group than in the less experienced endoscopist group (45%, 25/55 vs. 35%, 9/26), although the difference was not significant (P = 0.50). The sensitivity of NBI in the less experienced endoscopist group was 43% in the former half of patients, and increased to 60% in the latter half of patients. In the per-patient-based analysis, the sensitivity of NBI was significantly higher in the experienced endoscopist group (100%) than in the less experienced endoscopist group (100 vs. 69%, respectively; P = 0.04). The positive predictive values of the experienced endoscopist group and the less experienced endoscopist group were similar, and were 48 and 47%, respectively. In conclusion, compared with the gold standard of chromoendoscopy with iodine staining, the sensitivity of NBI for screening of mucosal high-grade neoplasia was 100% with the experienced endoscopists but was low with the less experienced endoscopists. Electronic chromoendoscopy with NBI is a promising screening tool in these high-risk patients with esophageal mucosal high-grade neoplasia, particularly when performed by endoscopists with experience of using NBI.
机译：窄带成像（NBI）是一种新颖的无创光学技术，它使用反射光来可视化器官表面。但是，很少有前瞻性研究检查NBI筛查食管癌的疗效。为了比较NBI内窥镜检查在有经验的内镜医师和经验不足的内镜医师之间筛查食管鳞状粘膜高级肿瘤的诊断率。有食管肿瘤或头颈癌病史的患者接受NBI内镜筛查食管肿瘤，然后使用碘染色进行内镜检查。活检标本取自未染色的碘病灶，黏膜高级别肿瘤的组织学结果作为参考标准。主要结果是NBI对检测新病变的敏感性。次要结果是NBI的阳性预测值以及每个病灶的NBI的敏感性，特异性，阳性预测值，阴性预测值和准确性。共有350例患者（经验丰富的内镜医师170例，经验不足的内镜医师180例）接受了内窥镜检查。总共检测到42个新的粘膜高级肿瘤病变（经验丰富的内镜医师组为25个，经验较少的内镜医师组为17个）。在基于病灶的分析中，经验丰富的内镜医师组的敏感性（100％; 25/25）与经验较少的内镜医师组（53％; 9/17）相比明显更高（P <0.001）。经验丰富的内镜医师组的NBI阳性预测值高于经验不足的内镜医师组（45％，25/55 vs. 35％，9/26），尽管差异不显着（P = 0.50）。经验较少的内镜医师组中，NBI的敏感性在前一半患者中为43％，而在后一半患者中增加为60％。在基于患者的分析中，经验丰富的内镜医师组的NBI敏感性（100％）显着高于经验不足的内镜医师组（分别为100％和69％; P = 0.04）。有经验的内镜医师组和经验不足的内镜医师组的阳性预测值相似，分别为48％和47％。总之，与有碘镜的内窥镜检查黄金标准相比，有经验的内镜医师对NBI筛查粘膜高级别肿瘤的敏感性为100％，而对经验较少的内镜医师则为低。带NBI的电子色谱内窥镜检查对于这些高风险的食管粘膜高度瘤形成的高危患者是一种有前途的筛查工具，尤其是由具有NBI经验的内镜医师进行时。

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