Expert assessment of infiltration depth and recommendation of endoscopic resection technique in early Barrett cancer.

IF 5.8 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY United European Gastroenterology Journal Pub Date : 2024-09-01 Epub Date: 2024-06-14 DOI:10.1002/ueg2.12604
Fadi Younis, Thomas Rösch, Torsten Beyna, Alanna Ebigbo, Siegbert Faiss, Andrea May, Oliver Pech, Philip Dautel, Mario Anders, Till Clauditz, Katharina Zimmermann-Fraedrich, Susanne Sehner, Guido Schachschal
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Abstract

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.

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专家评估早期巴雷特癌的浸润深度并推荐内窥镜切除技术。
背景:早期巴雷特癌可通过内镜切除术进行根治性治疗。然而,切除技术--内镜下粘膜切除术(EMR)或粘膜下剥离术(ESD)--的选择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:从我们的内镜数据库中选取了 202 例早期巴雷特食管癌病例(82% 为男性,平均年龄 66.9 岁)(73.3% 为 T1a 期,26.7% 为 T1b 期)的三到四张高质量图像(包括概览和特写)。我们向 9 位巴雷特食管专家展示了这些图像以及患者的临床数据(年龄、性别、巴雷特食管长度)和活检结果。专家们被要求预测浸润深度(T1b 与 T1a),并建议适当的内镜切除技术(EMR 或 ESD 或手术)。同时还确定了这些参数的观察者间变异性(卡帕值):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);卡帕值为 0.41。巴黎分级(kappa 0.51)和建议的治疗方法也因专家而异。在事后分析中,只有根据巴黎分类法被归类为隐形或扁平的病灶(IIB;占所有病例的 25%)与建议的切除技术之间的相关性较好:在这一分组中,超过80%的病例建议采用EMR,完全(基底R0)切除率很高(平均88.1%):结论:由专家通过内窥镜精确区分巴雷特食管癌的粘膜和粘膜下受累情况,并以此作为选择切除技术的依据,其预测价值有限,且观察者之间的变异性很高。看来,主要为隐形/扁平病变的食管癌在采用内镜下切除术治疗时可能会取得良好的切除效果,但这种分层策略还需进一步研究评估。
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来源期刊
United European Gastroenterology Journal
United European Gastroenterology Journal GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
10.50
自引率
13.30%
发文量
147
期刊介绍: United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
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