AbstractPurpose: To examine whether submucosal saline injection (SSI) can improve traditional endoscopic ultrasound (EUS) accuracy in distinguishing between T1a and T1b stage esophageal squamous cell carcinoma (ESCC). Experimental Design: Patients with T1N0M0 stage ESCC (n = 180) ages 18 to 85 years were enrolled between February 14, 2012 to June 4, 2018 at Sun Yat-sen University Cancer Center (Guangdong, China). They were randomly assigned (1:1) to receive either EUS examination after 3–5 mL SSI or EUS only examination. All the patients were referred to thoracic surgeons to receive endoscopic resection (ER) or esophagectomy 5 to 10 days after EUS examination. Standard EUS criteria were used to preoperatively stage the ESCC cases, and surgical pathology reports after referral were used to postoperatively stage the cases. The primary endpoint was the diagnostic accuracy of T1b staging [defined as the sum of the true positive (T1b) and true negative (T1a) cases divided by the total number of cases]. Results: Among the per-protocol population, the SSI+EUS group (n = 81) was superior to the EUS-only group (n = 85) in terms of the diagnostic accuracy for T1b staging [93.8% (95% confidence interval (CI), 88.6–99.1) vs. 65.9% (95% CI, 55.8–76.0); P < 0.001]. The positive predictive value of SSI+EUS for diagnosing T1b ESCC reached 90.9% (95% CI, 81.1–100), which was significantly superior to that of EUS only [0.576 (0.450-0.702), P = 0.001]. Conclusions: SSI significantly improves the diagnostic accuracy of EUS in distinguishing between T1a and T1b ESCC, which might help avoid unnecessary esophagectomy and diagnostic ER.

背景与目的 鼻咽癌(nasopharyngeal carcinoma,NPC)患者接受放射治疗后普遍出现咽后淋巴结(retropharyngeal lymph nodes,RLNs)增大.病理学检查结果决定了对增大RLNs最佳治疗方案的选择.然而,在临床上RLN取样难度大.我们最近开发了一种内镜超声引导下细针抽吸(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)的新型微创技术,可取到足够的RLN组织用以病理学或细胞学诊断.方法 纳入30例经核磁共振成像(magnetic resonance imaging,MRI)检测疑似放疗后出现RLN转移的NPC患者.EUS探头经鼻孔置入鼻咽,然后使用EUS扫描咽后间隙并在颈动脉鞘前定位RLN,随后进行EUS-FNA.对EUS-FNA法从RLN组织取样的安全性和有效性进行评估.结果 采用EUS-FNA法成功地对所有患者进行了组织取样.在30例患者中,23例经1次EUS-FNA取样后通过病理学或细胞学检查确认了活检组织中存在癌细胞.有7例患者经1次EUS-FNA活检后未确认存在癌细胞,随后再次采用EUS-FNA活检重新分析,又有2例被确认存在癌细胞;另外5例未确认存在癌细胞的患者密切随访3个月,每月进行1次MRI.随访3个月后,3例患者由于RLNs直径保持稳定或减小而被认为未患肿瘤;剩余2例表现出疾病进展的患者进行了第3次EUS-FNA活检,进一步确认为癌细胞阳性.本文所报道的整个队列中,EUS-FNA过程无任何严重并发症发生.结论 采用EUS-FNA法对疑似NPC复发患者的RLNs取样是一种安全有效的诊断方法.

Objective: This study aimed to present a novel technique for stapler-assisted laryngectomy under direct visualization using a videoendoscope with narrow-band imaging (NBI-endoscopy). Methods: A case series of five consecutive patients were treated with stapler-assisted total laryngectomy from December 2014 to March 2016. The technique involved monitoring the stapler closure of laryngopharyngeal cavity under NBI-endoscopic vision, triple checking of neo-pharynx cavity by an endoscopic view inside and transillumination verification outside, air leakage test, and guiding the insertion of feeding tube under direct visualization. The main evaluation of this study was pharyngocutaneous fistula, surgical margin, and oral feeding time. Results: All the patients healed well without a pharyngocutaneous fistula. The mean of surgical time, oral feeding, and hospitalization time were 40 min, 6 days, and 8 days, respectively. Conclusion: This study demonstrated a technique simple to learn and associated with decreased complication rates, which could be safe and efficient for stapler-assisted laryngectomy.

BACKGROUND:Invasive mediastinal lymph node staging is essential to resectable non-small cell lung cancer (NSCLC) patients. This retrospective study aimed to compare the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) against cervical mediastinoscopy (CMS) in radiologically enlarged mediastinal lymph nodes.METHODS:Retrospective data were collected from January 2009 to March 2016. Suspected lung cancer patients with enlarged mediastinal lymph nodes (short axis ≥10 mm), underwent EBUS-TBNA or CMS for invasive mediastinal staging were enrolled. Substantial radical resection with systematic mediastinal lymphadenectomy (SML) was used as the gold standard. Mediastinal lymph nodes diagnostic comparison and N staging analysis were conducted in this study.RESULTS:Fifty-five patients received EBUS-TBNA and one hundred and ninety patients received CMS were included into the analysis set. In per case analysis, no significant differences were seen between EBUS-TBNA and CMS in N staging accuracy (83.6% vs. 78.9%, P=0.444). EBUS-TBNA had significantly higher sensitivity than CMS (82.4% vs. 47.6%, P=0.039) in malignant lymph nodes diagnosis. In lymph nodes diagnosis comparison (station #2, #4 and #7), both EBUS-TBNA and CMS showed high diagnostic sensitivity, specificity and accuracy (82.4% vs. 94.7%, P=0.130; 97.4% vs. 100%, P=0.173; 98.8% vs. 92.9%, P=0.025; respectively), CMS had slightly better diagnostic accuracy rate than EBUS-TBNA. Malignant lymph nodes had longer short axis than benign nodes (mean 14.2 vs. 6.5 mm, P<0.001). In lymph nodes with a short axis ≥15 mm, the malignant rate was 48.8%. More complications and injuries were found in patients receiving CMS.CONCLUSIONS:For clinically suspected lung cancers with enlarged mediastinal lymph nodes, both EBUS-TBNA and CMS are favorable invasive mediastinal staging options. EBUS-TBNA may be preferred for its higher malignant diagnostic sensitivity and fewer complications.

Background Enlarged retropharyngeal lymph nodes (RLNs) are very common in patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy. The most suitable treatment option for enlarged RLNs depends on the pathological results. However, RLN sampling is difficult and imminent in the clinic setting. We recently developed a novel minimally invasive technique termed endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for sampling RLN tissues sufficient for pathological or cytological diagnosis. Methods We enrolled 30 post-radiotherapy patients with NPC with suspected RLN metastasis detected via magnetic resonance imaging (MRI). The EUS probe was introduced into the nasopharynx via the nostrils, and EUS was then used to scan the retropharyngeal space and locate the RLN in the anterior carotid sheath. EUS-FNA was subsequently performed. The safety and efficacy of using EUS-FNA to sample the RLN tissues were assessed. Results Strips of tissue were successfully sampled from all patients using EUS-FNA. Of the 30 patients, 23 were confirmed to have cancer cells in the biopsied tissues via pathology or cytology examinations with 1 EUS-FNA biopsy session. The seven cases without confirmed cancer cells were subsequently reanalyzed by using another EUS-FNA biopsy session, and two more cases were confirmed possessing cancer cells. The other five patients without confirmed cancer cells were closely followed with MRI every month for 3 months. After follow-up for 3 months, three patients were still considered cancer-free due to the presence of RLNs with stable or shrinking diameters. The rest two patients who showed progressive disease underwent a third EUS-FNA biopsy procedure and were further confirmed to be cancer cell-positive. In the whole cohort reported here, the EUS-FNA procedure was not associated with any severe complications. Conclusion EUS-FNA is a safe and effective diagnostic approach for sampling tissues from the RLNs in patients with suspected recurrent NPC.

Esophageal neurofibroma is a rare type of benign esophageal tumor. We presented a case of a 63-year-old man with a 12-cm diameter upper-thoracic esophageal submucosal tumor. Surgery of a thoracotomy was performed to remove the lesion. The postoperative course was uneventful and the patient was discharged on the postoperative day 10. Immunohistochemical staining confirmed the diagnosis of esophageal neurofibroma.

Abnormal thickened lesions of the gastric wall are usually covered with normal mucosa. Conventional endoscopic biopsies often do not yield sufficient positive histological results for clinical treatment. To increase the rate of diagnosis of conventional endoscopic biopsy-negative gastric wall thickening, we used an endoscopic submucosal dissection (ESD)-like sampling method under endoscopic ultrasound (EUS) guidance to obtain tissue of gastric wall-thickening lesions. Between 2012 and 2016, patients with gastric wall thickening (as identified by computed tomography (CT), EUS or other imaging methods that showed no positive findings in repeating conventional endoscopic biopsy) underwent via mucosa incision EUS-guided sampling. Final diagnosis was determined after surgical or biopsy pathology. A total of 10 patients with gastric wall thickening were included in this study. Eight cases received definite results, whereas in two cases the biopsy results were ambiguous and in these two patients poorly differentiated adenocarcinoma was determined by postoperative pathology. The results of the cases presented in this study demonstrated that via mucosa incision EUS-guided sampling provided a complementary option for the diagnosis of conventional endoscopic biopsy-negative gastric wall thickening.

e20066 Background: Invasive mediastinal lymph node staging is essential for resectable lung cancers. This retrospective study compares the diagnosis yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and cervical mediastinoscopy (CMS). Methods: Consecutive patients were analyzed from Jan 2009 to March 2016. Only pathologically confirmed results were accepted, and systematic mediastinal lymphadenectomy (SML) were used as the standard. The disease diagnosis and N stagingaccuracywere compared in this study. Results: 103 EBUS-TBNA patients and 232 CMS patients were included, 1014 mediastinal lymph nodes were biopsied in lung cancer patients. In per case analysis, there was no significant differences between EBUS-TBNA and CMS in disease diagnosis accuracy (89.4% vs. 81.2%, P = 0.097), and no significant difference in N staging accuracy (75.0% vs. 78.3%, P = 0.629). However, EBUS-TBNA had significantly higher disease diagnosis sensitivity than CMS (82.4% vs. 47.6%, P < 0.001). In lymph nodes diagnosis comparison (station #2, #4 and #7), both EBUS-TBNA and CMS showed very high accuracy, sensitivity, and specificity (94.7% vs. 99.6%, 88.6% vs. 94.8%, 97.2% vs. 100%), however CMS were slightly better. Positive lymph nodes had longer major and minor axes than negative nodes, and the positive rateswere as high as 59.2% in lymph nodes with a minor axis measuring ≥21mm. More complications and injuries were found in patients receiving CMS. Conclusions: For clinically suspected lung cancers, both EBUS-TBNA and CMS are favorable options for invasive mediastinal staging. EBUS-TBNA may be preferred for its higher disease diagnosis sensitivity and fewer complications.

Esophageal squamous cell carcinoma (ESCC) is known for its rapid progression and poor outcomes.China has the highest incidence and mortality in the world.Diagnoses made at early stages and accurate staging are associated with better outcomes, all of which can play a significant role in the selection of treatment protocols.ESCC is staged according to the widely accepted TNM system.Common imaging modalities used in staging ESCC before treatment include endoscopy, computed tomography (CT), positron emission tomography (PET) and magnetic resonance imaging (MRI).Endoscopic ultrasound is useful for staging tumor depth and nodal status.Narrow band imaging is valuable for early stage disease assessment.CT and PET provide additional valuable information regarding node and metastasis staging.The ability of MRI to delineate ESCC is continuously being improved and adds information regarding locoregional status to routine examinations.

目的 分析广州市越秀区大肠癌结肠镜精筛的前期结果,为下一步工作的开展提供借鉴.方法 强烈建议通过初筛确定的大肠癌高危人群行结肠镜检查.详细记录结肠镜检查结果并进行统计分析.结果 2015年1-12月共有1 031例高危人群接受结肠镜检查,其中男374例(36.3％),女657例(63.7％).结肠镜检查发现异常380例(36.9％),其中息肉、炎症或肿瘤361例(35.0％),大肠癌13例(检出率1.3％),息肉327例(检出率31.7％),腺瘤239例(检出率23.2％),进展期腺瘤140例(检出率13.6％).大肠癌在不同性别及年龄中的检出率差异无统计学意义(P＞0.05).男性的腺瘤及进展期腺瘤检出率均显著高于女性.腺瘤及进展期腺瘤的检出率随年龄增长也显著提高.结论 结肠镜检查是检出结直肠癌及癌前病变的有效筛查手段;同时应加强对男性高危人群的宣教,提高其参加筛查的顺应性.

BACKGROUND:Treatment options and prognosis of esophageal squamous cell carcinoma (ESCC) depend on the primary tumor depth (T-staging) and regional lymph node status (N-staging). Endoscopic ultrasound (EUS) has emerged as a useful staging tool, but studies regarding its benefits have been variable. The objective of this study was to evaluate the diagnostic accuracy of EUS for detecting preoperative ESCC.METHODS:We included in our meta-analysis studies involving EUS-based staging of preoperative ESCC compared with pathological staging. Using a random-effects model, we performed a meta-analysis of the accuracy of EUS by calculating pooled estimates of sensitivity, specificity and the diagnostic odds ratio. In addition, we created a summary receiver operating characteristic (SROC) curve.RESULTS:Forty-four studies (n = 2880) met the inclusion criteria. The pooled sensitivity and specificity of T1 were 77% (95%CI: 73 to 80) and 95% (95%CI: 94 to 96). Among the T1 patients, EUS had a pooled sensitivity in differentiating T1a and T1b of 84% (95%CI: 80 to 88) and 83% (95%CI: 80 to 86), and a specificity of 91% (95%CI: 88 to 94) and 89% (95%CI: 86 to 92). To stage T4, EUS had a pooled sensitivity of 84% (95%CI: 79 to 89) and a specificity of 96% (95%CI: 95 to 97). The overall accuracy of EUS for T-staging was 79% (95%CI: 77 to 80), and for N-staging, 71% (95%CI: 69 to 73).CONCLUSIONS:EUS has good diagnostic accuracy for staging ESCC, which has better performance in T1 sub-staging (T1a and T1b) and advanced disease (T4).

BACKGROUND:The preoperative detection of recurrent laryngeal nerve lymph node (RLN LN) metastasis provides important information for the treatment of esophageal cancer. We investigated the possibility of applying endobronchial ultrasonography (EBUS) with conventional preoperative endoscopic ultrasonography (EUS) and computerized tomography (CT) examination to evaluate RLN LN metastasis in patients with esophageal cancer. METHODS:A total of 115 patients with advanced thoracic esophageal cancer underwent EBUS examinations. Patients also underwent EUS and CT imaging as reference diagnostic methods. Positron emission tomography /computed tomography (PET/CT) was also introduced in partial patients as reference method. The preoperative evaluation of RLN LN metastasis was compared with the surgical and pathological staging in 94 patients who underwent radical surgery. RESULTS:The sensitivities of the preoperative evaluations of RLN LN metastasis by EBUS, EUS and CT were 67.6%, 32.4% and 29.4%, respectively. The sensitivity of EBUS was significantly different from that of EUS or CT, especially in the detection of right RLN LNs. In addition, according to the extra data from reference method, PET/CT was not superior to EBUS or EUS in detecting RLN LN metastasis. Among all 115 patients, 21 patients who were diagnosed with tracheal invasions by EUS or EBUS avoided radical surgery. Another 94 patients who were diagnosed as negative for tracheobronchial tree invasion by EUS and EBUS had no positive findings in radical surgery. CONCLUSIONS:EBUS can enhance the preoperative sensitivity of the detection of RLN LN metastasis in cases of thoracic esophageal cancer and is a useful complementary examination to conventional preoperative EUS and CT, which can alert thoracic surgeons to the possibility of a greater range of preoperative lymph node dissection. EBUS may also indicate tracheal invasion in cases of esophageal stricture.

AIM To investigate the accuracy of Endoscopic ultrasound (EUS) in staging and sub-staging T1a and T1b esophageal squamous cell carcinoma (ESCC). METHODS A retrospective analysis involving 72 patients with pathologically confirmed T1a or T1b ESCC, was undertaken between January 2005 and December 2011 in Sun Yat-sen University Cancer Center. The accuracy and efficiency of EUS for detecting stages T1a and T1b ESCC were examined. RESULTS The overall accuracy of EUS for detecting stage T1a or T1b ESCC was 70.8% (51/72), and the sensitivity was 74.3%. 77.8% (7/9) of lesions originated in the upper thoracic region, 73.1% (38/52) in the mid-thoracic region and 72.7% (8/11) in the lower thoracic region. Multivariate analysis revealed that the diagnostic accuracy of EUS was closely related to lesion length (F = 4.984, P = 0.029). CONCLUSION EUS demonstrated median degree of accuracy for distinguishing between stages T1a and T1b ESCC. Therefore, it is necessary to improve EUS for staging early ESCC.

目的 探讨利用胆道造影导管进行黏膜下注射减少内镜黏膜下剥离(endoscopic submucosal dissection,ESD)术中出血的应用价值.方法 将上消化道早期癌或黏膜重度不典型增生而接受ESD术的50例患者随机分两组,术中分别采用传统黏膜注射针和胆道造影导管进行黏膜下注射,统计患者黏膜下注射后引起的出血次数/黏膜下注射次数的比值以及单位面积病灶剥离时间,分析两组间差异是否有统计学意义.结果 使用胆道造影管行黏膜下注射的患者注射后出血几率和单位面积黏膜切开所需时间均小于采用传统黏膜注射针组.结论 利用胆道造影管进行黏膜下注射有助减少ESD术中出血,缩短ESD手术时间,是值得探索的一种改良方法.

Objective To investigate the role of insulin-like growth factor (IGF)-1 and its receptor (IGF1R) in the formation and development of colorectal carcinoma.Methods Colorectal tissue and matching serum samples were collected from patients with adenomatous polyps or carcinoma and healthy control subjects. IGF1R mRNA levels were determined via quantitative real-time reverse transcription-polymerase chain reaction. Serum IGF1 was quantified using enzyme-linked immunosorbent assay.Results Serum IGF1 concentrations and mucosal IGF1R mRNA levels were significantly higher in patients with adenomatous polyps (n=24) or carcinoma (n=13) compared with healthy control subjects (n=13). There was a significant positive correlation between serum IGF1 and mucosal IGF1R mRNA in patients with adenomatous polyps.Conclusions High circulating IGF1 concentrations and mucosal IGF1R expression may play important roles in both the formation and development of colorectal carcinoma. IGF1 and its receptor may be activated before carcinogenesis, and may promote the growth and malignant transformation of adenomatous polyps. IGF1 and IGF1R may be useful biomarkers for evaluating the stage and risk of carcinogenesis.

目的 探讨内镜下止血夹治疗消化道肿瘤术后吻合口出血的价值.方法 14例术后发现吻合口出血的消化道肿瘤病例,包括食管癌5例、胃癌3例、胃间质瘤2例及直肠癌4例,接受内镜下止血夹治疗并观察其止血效果.结果 14例患者中,除1例胃癌患者因出血量大难以观察出血部位外,其余13例患者均内镜下止血成功.结论 消化道肿瘤术后吻合口可能因吻合时黏膜撕裂或黏膜下血管未能完全封闭导致术后出血,采用内镜下止血夹夹闭出血点对治疗吻合口出血、避免再次开放性手术具有良好的应用价值.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for lung cancer diagnosis and lymph node staging. The purpose of this study was to investigate EBUS-TBNA for managing mediastinal and hilar lymphadenopathies without intrapulmonary masses. We retrospectively reviewed our EBUS-TBNA database that was obtained between August 2010 and October 2012. Mediastinal and hilar lymphadenopathies of unknown origin and in the absence of known pulmonary malignancies were included. Final diagnoses were determined by EBUS-TBNA, surgery, and/or clinical follow-up for at least 6 months. Sensitivity, specificity, accuracy, and positive and negative predictive values were determined using standard statistical methods. We identified 128 patients with mediastinal and hilar lymphadenopathies and without intrapulmonary masses. EBUS-TBNA was successfully performed to obtain samples from 161 lymph nodes and mediastinal masses. EBUS-TBNA was diagnostic for 119 of 128 patients (93.0%) for all disease categories. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of EBUS-TBNA were 89.8, 100, 100, 81.6, and 93.0%, respectively. The procedures were uneventful and there were no severe complications. EBUS-TBNA is a safe, minimally invasive approach for diagnosing mediastinal and hilar lymphadenopathies without intrapulmonary masses. It obviates the need for more invasive procedures for tissue sampling of the mediastinum and hilum.

Objective To investigate the role of casein kinase 2 (CK2) selective inhibitor tribromoisocyanuric acid (TBCA) in androgen receptor (AR) transactivation,cell proliferation and viability in prostate cancer cell lines,and explore a new chemotherapy for prostate cancer.Methods Prostate cancer cell lines were prepared.With TBCA treatment,Alamar-blue assay was performed to assess cell proliferation and viability in C4-2 cells and flow cytometry was performed for cell cycle analysis in C4-2 and 22Rvl cells; while immunofluorescence staining was performed to determine AR nuclear translocationin in PC-3/AR cells with R1881 pretreatment,and luciferase gene reporter assay was performed to determine AR transactivation in LNCaP cells; Reverse transcription-polymerase chain reaction (RT-PCR) was performed to evaluate the mRNA level of prostate specific antigen (PSA).Results With TBCA treatment,Alamar-blue reading decreased in a dose-dependent manner,and the 50％ inhibitory concentration ( IC50 ) was around 25 mol/L.Significant G2/M arrest was detected in C4-2 and 22Rvl cells.R1881-induced AR nuclear localization was reduced significantly ( P ＜ 0.01 ).R1881 -stimulated ARE-LUC reporter activity in LNCaP cells decreased with reduced level of PSA mRNA,which was an AR endogenous target( P ＜ 0.05 ).Conclusion The selective CK2 inhibitor TBCA can dramatically inhibite cell proliferation and cause a G2/M phase arrest in prostate cancer cells.

Objective To investigate the relationship between the expression of insulin-like growth factor-1 receptor (IGF-1 R) and the pit patterns of colorectal polyps,and discuss its clinical significance.Methods The totals of 47 colorectal polyps were collected from patients undergoing colonoscopy polypectomy.The pit patterns were classified according to the Kudo classification scheme.Immunohistochemistry was employed to detect the expression of IGF-1R.Spearman' s rank correlation analysis was utilized to demonstrate the relationship between the pit patterns and the expression of 1GF-1 R.Results In 47 colorectal polyps,8 polyps showed type Ⅱ pit pattern,6 polyps type Ⅲ L,30 polyps type Ⅳ,and 3 polyps type V.Most of the polyps with type Ⅱ pit pattem were negative for the expression of IGF-1R.The polyps with type Ⅳ or type V pit pattern showed up-regulated expression of IGF-1 R.The polyps with type Ⅲ L pit pattern showed moderate IGF-1 R expression.The pit pattern of polyps showed a significant correlation with the level of IGF-1 R expression (rs =0.432,P ＜ 0.05 ).Conclusion The expression of IGF-1R may affect the proliferation and anti-apoptosis of epithelia,which causes the morphological change of colorectal mucosal crypt.This result suggests that the over-expression of IGF-1R is related with the neoplastic initiation of colorectal cancer and can be used for evaluation of the risk of carcinogenesis.

The management of postoperative leaks into the mediastinum after esophagectomy remains a challenge. We describe our clinical management of this complication through endoscopic transluminal drainage. Between 2008 and 2011, 4 patients with esophageal squamous cell carcinoma (ESCC) who underwent McKeown-type esophagectomy with two-field lymphadenectomy experienced complicated anastomotic fistulae in the presence of superior mediastinal sepsis. All 4 patients underwent endoscopic transluminal drainage, and all survived. The mean healing period was 50 days (range, 31 to 58 days), the mean stay in the intensive care unit was 7.3 days (range, 1 to 18 days), and the mean hospital stay was 64.5 days (range, 49 to 70 days). Endoscopically guided transluminal drainage should be considered for ESCC patients with superior mediastinal fistulae after esophagectomy.