Occult dysplasia is disclosed by Lugol chromoendoscopy in alcoholics at high risk for squamous cell carcinoma of the esophagus.-猫眼课题宝

DOI：

10.1055/s-1999-122

发表时间：

1999-05

期刊：

Endoscopy

影响因子：

9.3

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

R. Fagundes;S. Barros;Antonio Carlos Kruel Putten;E. Mello;M. B. Wagner;Luiz Augusto Peukert Bassi Bassi-Luiz-Augusto-Peukert-Bassi-Bassi-2228831507;M. A. Bombassaro;D. Gobbi;E. B. Souto

背景和研究目的食管鳞状细胞癌（SCCE）在疾病已经进展的晚期才出现症状，这导致其预后不良。暴露于与这种癌症的发展相关的已知风险因素的无症状个体的食管镜检查可能有助于早期癌或癌前病变的诊断;然而，传统的食管镜检查不够准确。本研究的目的是衡量卢戈食管色素内窥镜检查（LCE）作为一种内窥镜技术检测高危患者异型增生的价值。患者和方法我们研究了190名35岁以上的男性患者，他们在10年内每天饮用超过80 g的酒精，超过10支香烟和超过500 ml的“马泰”（草药的热输液）。所有患者均接受常规上消化道内镜检查，然后进行LCE，即在整个食管上喷洒3%的Lugol。所有患者均否认吞咽困难。从大于5 mm的任何未染色区域以及所有个体的染色区域获得活检。由两名不知道活检部位的病理学家独立分析活检。所有常规食管镜检查均显示正常粘膜，除了两个可疑的小隆起病变，经组织学证实为SCCE。这两例病例从统计分析中排除。结果LCE发现23例患者的食管黏膜未染色，其余165例患者的食管黏膜染色均匀。从这23个未染色区域进行的活检显示6例不典型增生（2例高度不典型增生和4例低度不典型增生），从165个染色区域在食管中段进行的活检显示7例低度不典型增生。这些个体中发育异常病变的患病率较高（6.9%），未染色区域的隐匿性发育异常明显高于染色区域（p = 0.0017）。LCE对非染色区与染色区的敏感性为46%，特异性为90%，阳性预测值为26%，阴性预测值为96%。两个独立的病理学家之间的协议是高的，kappa系数为0.64。结论：我们得出结论，滥用酒精，吸烟和消费“马黛茶”的人有很高的发育异常病变的患病率，可以更好地检测LCE。未染色区域的食管显示不典型增生的机会比均匀染色区域高8倍。LCE是一种简单而廉价的方法。它提高了异型增生的检测，应添加到传统的上消化道内镜检查的风险SCCE的患者。

BACKGROUND AND STUDY AIMS Squamous cell carcinoma of the esophagus (SCCE) becomes symptomatic at a late stage when the disease is already advanced, and this contributes to its poor prognosis. Esophagoscopy of asymptomatic individuals exposed to known risk factors associated with the development of this cancer may facilitate the diagnosis of early cancerous or precancerous lesions; however, conventional esophagoscopy is not accurate enough. The aim of this study was to measure the value of Lugol chromoendoscopy of the esophagus (LCE) as an endoscopic technique to detect dysplasia in patients at risk. PATIENTS AND METHODS We studied 190 male patients older than 35 attending an outpatient unit for alcoholics who consumed more than 80g of alcohol, more than 10 cigarettes and more than 500 ml 'maté' (a hot infusion of herbs) per day over 10 years. All underwent conventional upper gastrointestinal endoscopy followed by LCE, a spraying of Lugol 3% on the entire esophagus. All patients denied dysphagia. Biopsies were obtained from any unstained areas larger than 5mm and also from stained areas in all individuals. Biopsies were analyzed independently by two pathologists unaware of the biopsy sites. All conventional esophagoscopies showed normal mucosa, except for two suspicious small elevated lesions, confirmed histologically to be SCCE. These two cases were excluded from the statistical analysis. RESULTS The LCE found unstained areas in 23 patients and a uniformly stained esophageal mucosa in the remaining 165. Biopsies taken from these 23 unstained areas showed dysplasia in six (two high grade and four low grade), and the ones from the 165 stained areas taken at the middle esophagus showed low-grade dysplasia in seven. There was a high prevalence (6.9%) of dysplastic lesions in these individuals and occult dysplasia was significantly more frequent in unstained than stained areas (p = 0.0017). LCE showed a sensitivity of 46%, a specificity of 90%, a positive predictive value of 26% and a negative predicitve value of 96% when unstained areas were compared to stained ones. Agreement between two independent pathologists was high, with a kappa coefficient of 0.64. CONCLUSION We concluded that individuals who abuse alcohol, smoke and consume 'maté' have a high prevalence of dysplastic lesions that can be better detected by LCE. Esophagi with unstained areas had an eight-fold higher chance of revealing dysplasia than the uniformly stained ones. LCE is an easy and inexpensive method. It improves the detection of dysplasia and should be added to conventional upper GI endoscopy in patients at risk for SCCE.

Occult dysplasia is disclosed by Lugol chromoendoscopy in alcoholics at high risk for squamous cell carcinoma of the esophagus.

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