Zeng YT, Sun YY, Tan WC, Luo SA, Zou BH, Luo GY, Huang CY. Study of preoperative diagnostic modalities in Chinese patients with superficial esophageal squamous cell carcinoma. World J Gastrointest Surg 2022; 14(9): 986-996 [PMID: 36185565 DOI: 10.4240/wjgs.v14.i9.986]
Corresponding Author of This Article
Chun-Yu Huang, MD, PhD, Professor, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou 510060, Guangdong Province, China. huangchy@sysucc.org.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ya-Ting Zeng, Yu-Ying Sun, Wen-Cheng Tan, Shu-Ai Luo, Bi-Hui Zou, Guang-Yu Luo, Chun-Yu Huang, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Ya-Ting Zeng, Yu-Ying Sun, Wen-Cheng Tan, Shu-Ai Luo, Bi-Hui Zou, Guang-Yu Luo, Chun-Yu Huang, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Ya-Ting Zeng, Wen-Cheng Tan, Shu-Ai Luo, Bi-Hui Zou, Guang-Yu Luo, Chun-Yu Huang, Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Yu-Ying Sun, Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Author contributions: Zeng Y designed and performed the study and wrote the manuscript; Sun Y and Huang C contributed to the conception of the study; Tan W and Luo G helped perform the analysis with constructive discussions; Luo S and Zhou B collected the data;
Supported bythe Guangdong Esophageal Cancer Institute Science and Technology Program, No. M202013.
Institutional review board statement: This study was approved by the Ethics Committee of the Sun Yat-Sen University Cancer Center.
Informed consent statement: Informed consent from patients was waived by the Ethics Committee of the Sun Yat-Sen University Cancer Center.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Yu Huang, MD, PhD, Professor, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou 510060, Guangdong Province, China. huangchy@sysucc.org.cn
Received: June 9, 2022 Peer-review started: June 9, 2022 First decision: August 1, 2022 Revised: August 11, 2022 Accepted: September 8, 2022 Article in press: September 8, 2022 Published online: September 27, 2022 Processing time: 105 Days and 0.2 Hours
Abstract
BACKGROUND
Endoscopic ultrasonography (EUS) and magnifying endoscopy (ME) reliably determine indications for endoscopic resection in patients with superficial esophageal squamous cell carcinoma (SESCC). ME is widely accepted for predicting the invasion depth of superficial esophageal cancer with satisfying accuracy. However, the addition of EUS is controversial.
AIM
To evaluate the diagnostic efficiency of ME vs EUS for invasion depth prediction and investigate the influencing factors in patients with SESCC to determine the best diagnostic model in China.
METHODS
We retrospectively analyzed patients with suspected SESCC who completed both ME and EUS and then underwent endoscopic or surgical resection at Sun Yat-Sen University Cancer Center between January 2018 and December 2021. We evaluated and compared the diagnostic efficiency of EUS and ME according to histological results, and investigated the influencing factors.
RESULTS
We included 152 lesions from 144 patients in this study. The diagnostic accuracies of ME and EUS in differentiating invasion depth were not significantly different (73.0% and 66.4%, P = 0.24); both demonstrated moderate consistency with the pathological results (ME: kappa = 0.58, 95% confidence interval [CI]: 0.48-0.68, P < 0.01; EUS: kappa = 0.46, 95%CI: 0.34-0.57, P < 0.01). ME was significantly more accurate in the diagnosis of high-grade intraepithelial (HGIN) or carcinoma in situ (odds ratio [OR] = 3.62, 95%CI: 1.43-9.16, P = 0.007) subgroups. Using a miniature probe rather than conventional EUS can improve the accuracy of lesion depth determination (82.3% vs 49.3%, P < 0.01). Less than a quarter of circumferential occupation and application of a miniature probe were independent risk factors for the accuracy of tumor invasion depth as assessed by EUS (< 1/4 circumferential occupation: OR = 3.07, 95%CI: 1.04-9.10; application of a miniature probe: OR = 5.28, 95%CI: 2.41-11.59, P < 0.01). Of the 41 lesions (41/152, 27.0%) that were misdiagnosed by ME, 24 were corrected by EUS (24/41, 58.5%).
CONCLUSION
Preoperative diagnosis of SESCC should be conducted endoscopically using white light and magnification. In China, EUS can be added after obtaining patient consent. Use of a high-frequency miniature probe or miniature probe combined with conventional EUS is preferable.
Core Tip: Endoscopic ultrasonography (EUS) and magnifying endoscopy (ME) reliably determine indications for endoscopic resection in patients with superficial esophageal squamous cell carcinoma (SESCC). ME is a widely accepted method for predicting the invasion depth. However, the addition of EUS is controversial. We retrospectively analyzed Chinese patients with suspected SESCC who completed both ME and EUS and underwent resection at our facility. We found that EUS and ME demonstrated comparable accuracy and EUS can compensate for deficiencies inherent to ME in some cases. The miniature probe was best suited for detecting early-stage lesions. These findings may further improve diagnostic accuracy.
