内镜短期内重复筛查观察食管和贲门癌癌前自然史301例

目的:了解进展较快的食管和贲门癌前病变的时间,为寻找合适的筛查间隔提供线索.方法:在食管癌高发区河北涉县对40～69岁人群开展重复的内镜筛查.结果:301例重复筛查共观察到40例病情发生进展者,其中7例重度不典型增生中:1例首检为正常,间隔13个月检出重度不典型增生,1例首检为基底细胞增生,间隔7个月检出,4例首检为轻度不典型增生,分别间隔3个月、4个月、4个月、10.5个月检出,1例首检为中度不典型增生,间隔12.5个月检出;6例原位癌及黏膜内癌中:1例首检为轻度不典型增生,间隔48个月检出,2例中度不典型增生分别间隔4个月、13个月检出2例,3例重度不典型增生分别间隔3.5个月、9个月、17.5个月检出;3例浸润性癌中:1例中度不典型增生,间隔50个月检出、2例重度不典型增生间隔14个月和19个月检出.结论:食管和贲门癌前病变的滞留时间变异较大,有必要适当缩短筛查间隔,通过及时复查捕获那些进展较快、多点起源和首检遗漏的癌前病变.

Sojourn time observation of esophageal and cardia precancerous lesions by periodic endoscopic screening of 301 subjects in Shexian

Aim: To investigate sojourn time of rapid developing esophageal and cardia precancerous lesions.Methods:Periodic endoscopic screening was performed among 301 residents aged from 40 to 69 years in the high-incidence areas for esophageal cancer in Shexian, Hebei province.Results: Sojourn time for severe dysplasia (SD) was: 13 months after a baseline diagnosis of normal epithelium in 1 subject, 7 months after a baseline diagnosis of base cell hyperplasia(BCH) in 1 subject, 3 months, 4 months, 4 months, and 10.5 months after baseline diagnoses of mind dysplasia(mD) in 4 subjects, and 12.5 months after a baseline diagnosis of moderate dysplasia (MD) in 1 subject; Sojourn time for cancer in situ or intramucosal carcinoma was: 48 months after a baseline diagnosis of mD in 1 subject, 4 months and 13 months after baseline diagnoses of MD in 2 subjects, and 3.5 months, 9 months, and 17.5 months after baseline diagnoses of SD; and sojourn time for invasive cancer was: 50 months after a baseline diagnosis of MD in 1 subject, 14 months and 19 months after baseline diagnoses of SD in 2 subjects. Conclusion: Periodic screening with shorter intervals should be considered to control the number of interval cases due to rapid development, multifocal carcinogenesis, and false negative results in endoscopic biopsy sampling.