Effectiveness of Unsedated Transnasal Endoscopy With White-light, Flexible Spectral Imaging Color Enhancement, and Lugol Staining for Esophageal Cancer Screening in High-risk Patients
Effectiveness of Unsedated Transnasal Endoscopy With White-light, Flexible Spectral Imaging Color Enhancement, and Lugol Staining for Esophageal Cancer Screening in High-risk Patients
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DOI：
10.1097/mcg.0b013e3182617fc1
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发表时间：
2013-04-01
影响因子：
2.9
通讯作者：
Vaz Coelho, Luiz Gonzaga
中科院分区：
文献类型：
--
作者：
Arantes, Vitor;Albuquerque, Walton;Vaz Coelho, Luiz Gonzaga
背景和目的：在亚洲，经鼻内镜检查（TNE）已被提议用于筛查食管鳞状细胞癌（ESCC）。本研究旨在评估巴西患者接受非镇静TNE筛查的可行性和耐受性、ESCC在该人群中的患病率以及白光内镜（WLE）和数字色素内镜[柔性光谱成像彩色增强（FICE）]诊断食管肿瘤的有效性。这是一项诊断试验研究，入组了接受ESCC筛查的头颈部鳞状细胞癌（HNSCC）患者。患者的耐受性通过疼痛强度数字量表进行评定。干预措施包括未使用镇静剂的TNE与WLE和食管FICE检查，与盲法操作者以串联方式进行，然后进行卢戈染色。将WLE和FICE用于肿瘤检测的性能与参考标准（卢戈染色加组织学）进行比较。TNE在99.1%的患者中是可行的，92%的患者将不适评定为不存在或轻微。13例ESCC被检测到（12.3%），10例早期癌症（77%）。测试显示出优异的性能，WLE之间没有差异，（敏感性92.3%，特异性98.9%，准确性98.1%，曲线下面积0.995）和FICE（敏感性100%，特异性98.9%，准确性99%，曲线下面积0.956）。非镇静剂TNE是一种可行的，广泛接受的，有效的诊断工具，用于筛查ESCC。食管肿瘤发生率的升高加强了对HNSCC患者进行筛查的建议。WLE和FICE检测ESCC的产率相似。
Background and Aims: Transnasal endoscopy (TNE) has been proposed to screen for esophageal squamous cell cancer (ESCC) in Asia. This study aimed to assess the feasibility and tolerance of Brazilian patients to undergo unsedated TNE for screening, the prevalence of ESCC in this population, and the effectiveness of white-light endoscopy (WLE) and digital chromoendoscopy [flexible spectral imaging color enhancement (FICE)] to diagnose esophageal neoplasia.Patients and Methods: This was a diagnostic test study that enrolled patients with head and neck squamous cell cancer (HNSCC) referred to ESCC screening. Patients' tolerance was rated by a numeric pain intensity scale. Interventions included unsedated TNE with WLE and FICE examination of the esophagus, in a tandem manner with blinded operators, followed by lugol chromoscopy. Performance of WLE and FICE for neoplasia detection was compared with the reference standard (lugol chromoscopy plus histology).Results: A total of 106 patients were recruited. TNE was feasible in 99.1%, and 92% of the patients rated the discomfort as absent or minimal. Thirteen ESCC were detected (12.3%), with 10 early cancers (77%). The tests showed an excellent performance and there was no difference between WLE (sensitivity 92.3%, specificity 98.9%, accuracy 98.1%, area under curve 0.995) and FICE (sensitivity 100%, specificity 98.9%, accuracy 99%, area under curve 0.956) for esophageal neoplasia detection.Conclusions: Unsedated TNE is a feasible, well accepted, and efficient diagnostic tool for the screening of ESCC. The elevated rate of esophageal neoplasia strengthens the recommendations to screen patients with HNSCC. The yields of WLE and FICE were similar for ESCC detection.