摘要
背景与目的:食管癌的死亡率一直居高不下,主要是由于其早诊率较低。为提高食管癌的早诊率,本研究探讨在我国食管癌高发区应用直接内镜下碘染色进行普查提高食管癌早诊率的可行性。方法:应用直接内镜下碘染色在我国食管癌高发区对3164名高危人群进行3次普查,每个普查对象均在着色区取一块活检组织,且每例可疑病例也均在食管的不着色区取活检组织作病理检查,然后将食管鳞状上皮的着色情况与其对应的病理检查结果进行对照。结果:(1)早期食管癌100%碘染色阳性,染色级别多为Ⅰ级。早期食管癌检出率为1.6%～4.59%,中晚期食管癌的检出率为0.29%～1.09%,食管癌的早诊率均在75%以上。(2)食管鳞状上皮重度不典型增生95.6%碘染色阳性,其中91.3%病例碘染色级别为Ⅰ和Ⅱ级。食管鳞状上皮重度不典型增生检出率为4.49%～7.68%。(3)中度不典型增生96.6%碘染色阳性,73.3%病变染色级别为Ⅱ和Ⅲ级。(4)92.3%轻度不典型增生碘染色阳性,86.5%病变染色级别为Ⅱ和Ⅲ级。(5)而只有0.9%的炎症和0.4%的正常组织碘染色级别为Ⅰ和Ⅱ级,正常组织大多数为阴性或Ⅲ级。结论:在食管癌高发区应用直接内镜下碘染色进行普查,对早期食管癌及其癌前病变有较高的检出率。
BACKGROUND & OBJECTIVE:In order to improve early detection and visualization of esophageal premalignant lesion and carcinoma, this study was designed to explore significance of the screening by iodine staining of endoscopic examination in the area of high incidence of esophageal carcinoma. METHODS:Three screenings were completed through endoscopic examination for 3164 persons in high risk population. Esophageal epithelium was stained with iodine in endoscopic examination. According to mucosal color and pathological result, esophageal carcinoma and premalignant lesion were confirmed. RESULTS:After staining, the normal epithelium became brown and precancerous or malignant epithelium manifested yellow with sharp margin. (1) 100% early esophageal cancer was iodine staining positive, all lesions were grade Ⅰ to grade Ⅱ. The incidence rates of early esophageal carcinoma and advanced esophageal carcinoma were 1 60% 4 59% and 0 29% 1 09%, respectively. Early detection rate of esophageal carcinoma was all over 75%. (2) 95 6% severe dysplasia were staining positive; 91.3% lesion were grade Ⅰ and grade Ⅱ in staining. The incidence rate of severe dysplasia was 4 49% 7 68%. (3) 96 6% moderate dysplasia was positive in iodine staining, 73 3% lesion were grade Ⅱ and grade Ⅲ. (4) 92 3% mild dysplasia was positive in iodine staining; most of lesions were grade Ⅲ. (5) 0 9% esophagitis and 0.4% normal esophageal mucosal were grade Ⅰ and grade Ⅱ in iodine staining, most of lesion were negative or grade Ⅲ. CONCLUSION:The results demonstrated that the screening with endoscopic staining examination could improve early detection of esophageal carcinoma and precancerous lesion. Iodine staining showed highly sensitivity and specificity for identifying these precancerous and early squamous cancer lesions; it may be helpful for diagnosis of early esophageal carcinoma and precancerous lesion.
出处
《癌症》
SCIE
CAS
CSCD
北大核心
2003年第2期175-177,共3页
Chinese Journal of Cancer
基金
卫生部部属(管)医院临床学科重点项目(No:犤2001犦321号)
关键词
内镜
碘染色
食管癌
高发区
普查
早期诊断
Esophageal carcinoma
High incidence area
Endoscopy
Iodine staining
Screening
