联合内镜诊断模型在早期食管癌诊断中的应用价值探讨

目的探讨全新联合内镜诊断模型在提高早期食管癌诊断率中的应用价值。方法选取2018年1月至2019年1月期间就诊福建省食管癌早诊早治促进联盟中高发区多家医院疑诊早期食管癌/癌前病变患者共206例作为研究对象。根据病理诊断结果分为高级别上皮内瘤变/食管癌组和炎症/低级别上皮内瘤变组,对比超声内镜(EUS)、碘染色素内镜及放大电子染色内镜(ME-NBI)在早期食管癌中的诊断价值,并建立多种联合内镜诊断模型,创建受试者工作特征曲线(ROC曲线)评价其对早期食管癌的诊断价值。结果三种内镜诊断早期食管癌的敏感度依次为93.6%、83.2%及73.6%;特异度分别为37.0%、25%及55.6%;准确度分别为86.4%、82.0%及72.8%。单因素分析显示各内镜下表现(浸润深度、IPCL分型、碘染情况、草席征)对早期食管癌有鉴别意义(P<0.05)。在校准年龄、性别、病灶位置等因素后,纳入上述影响因素的联合内镜诊断模型诊断早期食管癌的灵敏度、特异度和准确度分别为95.6%、89.1%和80.6%,ROC曲线下面积为0.951。结论多种内镜联合诊断明显优于单一的内镜检查方法,结合EUS、ME-NBI、碘染色素内镜的联合内镜诊断模型可明显提高早期食管癌的诊断准确性。

The value of combined endoscopy diagnostic model in the diagnosis of early esophageal cancer

Objective To explore the clinical value of the novel combined endoscopy diagnostic model in improving the diagnosis rate of early esophageal cancer.Methods From January 2018 to January 2019,a total of 206 patients who were diagnosed with early esophageal cancer/precancerous lesions in the hospitals of Fujian Provincial Esophageal Cancer Union were selected as the research objects.According to the pathological diagnosis results,the patients were divided into high-grade intraepithelial neoplasia(HGIN)/esophageal cancer group and inflammation/low-grade intraepithelial neoplasia(LGIN)group.The clinical value of endoscopic ultrasonography(EUS),Chromoendoscopy with iodine staining and Magnified endoscopy with narrow band imaging(ME-NBI)in diagnosing early esophageal cancer were compared.A variety of combined endoscopy diagnostic models were established and the diagnostic value of the models were assessed by the use of receiver operating characteristic curve(ROC curve).Results The sensitivity of the three endoscopes in the diagnosis of early esophageal cancer was 93.6%,83.2%and 73.6%,respectively;the specificity was 37.0%,25%and 55.6%;the accuracy was 86.4%,82.0%and 72.8%,respectively.Univariate analysis showed that the endoscopic performance(infiltration depth,IPCL classification,iodine staining,tatami sign)had a differential significance for early esophageal cancer(P<0.05).After calibrating factors such as age,gender,and location of the lesion,the sensitivity,specificity,and accuracy of the combined endoscopy diagnostic model incorporating the above-mentioned influencing factors in the diagnosis of early esophageal cancer were 95.6%,89.1%,and 80.6%,respectively.The area under the ROC curve was 0.951.Conclusion Multiple endoscopy combined diagnosis is significantly better than a single endoscopy method,combined with EUS,ME-NBI,chromoendoscopy combined endoscopy diagnostic model can significantly improve the accuracy of early esophageal cancer diagnosis.