背景:早期Barrett癌可以通过内镜切除治疗。切除技术的选择,然而,内镜下黏膜切除术(EMR)或黏膜下剥离术(ESD)在很大程度上取决于内镜医师判断的假定浸润深度.然而,内镜诊断癌症浸润程度的准确性尚不清楚。
方法:来自202例早期Barrett食道癌患者(82%为男性,平均年龄66.9岁)从我们的内窥镜检查数据库中选择(T1a期为73.3%,T1b期为26.7%).向9名巴雷特食管专家展示了图像,与患者临床数据(年龄,性别,Barrett食管长度)和活检结果。专家被要求预测渗透深度(T1b与T1a),并建议适当的内窥镜切除技术(EMR或ESD,或手术)。还确定了这些参数的观察者间变异性(κ值)。
结果:诊断T1b与T1a浸润的总体阳性预测值(PPV)和阴性预测值(NPV)分别为40.7%(95%CI:36.7,44.8)和79.8%(95%CI:77.5,81.9)。卡伯值分别为0.41。巴黎分类(kappa0.51)和建议的治疗方法在专家之间也有所不同。在事后分析中,只有根据巴黎分类(IIB;所有病例的25%)分类为不可见或平坦的病变与建议的切除技术之间的相关性更好:在这个亚组中,在>80%的病例中建议使用EMR,具有较高的完全(基础R0)切除率(平均88.1%)。
结论:专家对Barrett食管癌粘膜和粘膜下受累的精确内镜区分作为选择切除技术的依据具有有限的预测价值和高度的观察者间差异。似乎主要是不可见/扁平的病变可能导致良好的切除结果时,通过EMR治疗,但这种分层策略必须在进一步的研究中进行评估.
BACKGROUND: Early Barrett cancer can be curatively treated by endoscopic resection. The choice of the resection technique, however-endoscopic mucosal resection (EMR) or submucosal dissection (ESD)-largely depends on the assumed infiltration depth as judged by the endoscopist. However, the accuracy of endoscopic diagnosis of the degree of cancer infiltration is not known.
METHODS: Three to four high-quality images (both in overview and close-up) from 202 of early Barrett esophagus cancer cases (82% men, mean age 66.9 years) were selected from our endoscopy database (73.3% stage T1a and 26.7% in stage T1b). Images were shown to 9 Barrett esophagus experts, with patients\' clinical data (age, sex, Barrett esophagus length) and biopsy results. The experts were asked to predict infiltration depth (T1b vs. T1a), and to suggest the appropriate endoscopic resection technique (EMR or ESD, or surgery). Interobserver variability (kappa values) was also determined for these parameters.
RESULTS: Overall positive (PPV) and negative predictive values (NPV) to diagnose T1b versus T1a infiltration were 40.7% (95% CI: 36.7, 44.8) and 79.8% (95% CI: 77.5, 81.9), respectively; kappa value was 0.41. Paris classification (kappa 0.51) and suggested treatment also varied between experts. In a post hoc analysis, only the correlation between lesions classified as invisible or flat according to the Paris classification (IIB; 25% of all cases) and the suggested resection technique was better: In this subgroup, EMR was recommended in >80% of cases, with a high complete (basal R0) resection rate (mean of 88.1%).
CONCLUSIONS: Precise endoscopic distinction between mucosal and submucosal involvement of Barrett esophagus cancer by experts as a basis for choosing the resection technique has limited predictive values and high interobserver variability. It seems that mainly invisible/flat lesions may result in good resection outcomes when treated by EMR, but this stratification strategy has to be assessed in further studies.