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| B2型血管预判浅表食管鳞状细胞癌浸润深度的应用价值 |
| The application value of type B2 vessels in predicting invasion depth of superficial esophageal squamous cell carcinoma |
| 投稿时间：2026-02-01 |
| DOI：10.3969/j.issn.1000-0399.2026.08.001 |
| 中文关键词: 浅表食管鳞状细胞癌 B2型血管 浸润深度 过度预判 预判不足 |
| 英文关键词: Superficial esophageal squamous cell carcinoma Type B2 IPCL vessels Invasion depth Over-prediction Under-prediction |
| 基金项目:国家自然科学基金项目(编号:82103040) |
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| 中文摘要: |
| 目的 探讨B2型血管预判浅表食管鳞状细胞癌浸润深度的应用价值。方法 回顾性分析2023年1月至2025年12月安徽医科大学第一附属医院收治的71例食管病变患者的临床资料，所有患者均接受窄带成像放大内镜（ME-NBI）检查且内镜下均可见B2型血管，经内镜黏膜下剥离术（ESD）术后病理证实为浅表食管鳞状细胞癌（SESCC）。根据B2型血管预判深度，结合病理结果，将患者分为正确预判组（n=18例）、过度预判组（n=34例）和预判不足组（n=19例）3组，分析3组患者临床特征、内镜下表现及组织学亚型差异。采用多元logistic回归模型筛选影响B2型血管预判SESCC浸润深度的相关因素，Kappa值用于评估B2型血管合并内镜特征的联合模型的诊断效能。结果 ME-NBI下单一B2型血管预判SESCC浸润深度的准确率仅为25.4%。差异性分析显示，病变部位、病变周长、内镜下高危形态学特征及显著角化在3组间差异均有统计学意义（P<0.05）。多元logistic回归分析结果显示，食管显著角化是B2型血管过度预判SESCC浸润深度的独立保护因素（OR=0.117,95%CI:0.022～0.616,P=0.011），内镜下高危形态学特征是B2型血管对SESCC浸润深度预判不足的独立危险因素（OR=15.091,95%CI:1.846～123.370,P=0.011）。B2型血管合并内镜下高危形态学特征的联合模型诊断浸润深度为SM2/SM3层病变的灵敏度为84.2%、特异度为88.5%，准确性为87.3%，诊断一致性较为显著（Kappa=0.692,P<0.05）。结论 临床单一应用B2型血管预判SESCC浸润深度的准确率较低。食管显著角化与B2型血管过度预判浸润深度有关，内镜下高危形态学特征与B2型血管预判浸润深度不足有关。B2型血管合并高危形态学特征的联合模型可提高对浸润深度为SM2/SM3的检出能力。 |
| 英文摘要: |
| Objective To explore the application value of type B2 vessels in predicting the invasion depth of superficial esophageal squamous cell carcinoma. Methods This retrospective study included 71 SESCC lesions treated with endoscopic submucosal dissection(ESD) at the First Affiliated Hospital of Anhui Medical University between January 2023 and December 2025. All lesions exhibited type B2 vessels on magnifying endoscopy with narrow-band imaging(ME-NBI). Based on final histopathology, the endoscopic predictions were categorized into three cohorts: accurate prediction(n=18), over-prediction(n=34), and under-prediction(n=19). Clinical characteristics, endoscopic findings, and histological subtypes were compared among the three groups. Logistic regression was applied to identify independent factors linked to prediction discordance. The Kappa coefficient was adopted to evaluate the diagnostic efficiency of type B2 IPCL vessels combined with endoscopic features. Results The accuracy of single type B2 IPCL vessels in predicting SESCC invasion depth under ME-NBI was only 25.4%. Comparative analysis showed that lesion location, lesion circumferential extent, high-risk endoscopic morphological features and marked esophageal keratinization differed significantly among the three groups(P<0.05). Multivariate logistic regression analysis demonstrated that marked esophageal keratinization was an independent protective factor against over-prediction of SESCC invasion depth by type B2 IPCL vessels(OR=0.117, 95%CI: 0.022～0.616, P=0.011), while high-risk endoscopic morphological features were independent risk factors for under-prediction(OR=15.091, 95%CI:1.846～123.370, P=0.011). The combination of type B2 IPCL vessels and high-risk endoscopic morphological features yielded a sensitivity of 84.2%, a specificity of 88.5% and an accuracy of 87.3% in identifying SM2/SM3 invasive lesions, with favorable diagnostic consistency(Kappa=0.692, P<0.05). Conclusion Single application of type B2 IPCL vessels shows low accuracy in predicting SESCC invasion depth in clinical practice. Marked esophageal keratinization is correlated with over-prediction, whereas high-risk endoscopic morphological features are associated with under-prediction of invasion depth. Combined evaluation of Type B2 IPCL vessels and high-risk morphological features can improve the identification ability of SM2/SM3 lesions, reduce clinical under-prediction, and optimize the selection of indications for ESD. |
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