DIAGNOSTIC ACCURACY OF PIT PATTERN AND VASCULAR PATTERN ANALYSES IN COLORECTAL LESIONS

Background: The aim of this prospective study is to compare the usefulness of magnifying narrow band imaging (NBI) and magnifying chromoendoscopy in the diagnosis of colorectal lesions. Methods: The subjects were 1185 patients who underwent a complete colonoscopic examination and endoscopic or surgical treatment, from January 2006 to February 2008. A total of 1473 lesions were evaluated (53 hyperplastic polyps, 1317 adenomas, 103 submucosally invasive cancers). The digital images with NBI or chromoendoscopy were recorded and diagnosed independently from each other by two endoscopists who were blinded to the final pathological diagnosis. Results: We could differentiate between neoplastic and non‐neoplastic lesions with sensitivity of 88.9%, specificity of 98.5% and accuracy of 98.2% according to the vascular pattern. By recognizing an irregular or sparse pattern with NBI, massively invasive submucosal cancer could be diagnosed with the sensitivity and specificity of 94.9% and 76.0%. Using chromoendoscopy, we could differentiate between neoplastic and non‐neoplastic lesions with sensitivity of 86.8% and specificity of 99.2%. We were able to differentiate between massively invasive cancers and slightly invasive cancers using the pit patterns with sensitivity of 89.7% and specificity of 88.0%. The specificity was superior to that of NBI colonoscopy. Conclusion: Both NBI and chromoendoscopy can be useful for distinguishing between neoplastic and non‐neoplastic lesions. In the diagnosis of submucosal cancer, pit pattern diagnosis was slightly superior to vascular pattern diagnosis. It is desirable to perform chromoendoscopy in addition to NBI for distinguishing between slightly and massively invasive submucosal cancer lesions and determining the treatment.     

Magnifying Endoscopy with Indigo Carmine Contrast for Differential Diagnosis of Neoplastic and Nonneoplastic Colonic Polyps

This study describes the feasibility of magnifying colonoscopy with indigo carmine dye contrast to distinguish neoplastic and nonneoplastic colonic polyps. This study sampled consecutive patients undergoing colonoscopy using an Olympus CF240ZI from January to October 2000 at Chang-Gung Memorial Hospital, Lin-Kou Medical Center. This study analyzed a total of 270 polyps. Indigo carmine (0.2%) was sprayed directly on the mucosa surface before observing the crypts using a magnifying colonoscope (1.5x-100x). The pit patterns were described using the classification proposed by Kudo. Finally, polypectomy or biopsy was performed for histological diagnosis. The study identified 155 adenomas, 99 hyperplastic polyps, 9 adenocarcinomas, and 7 other nonneoplastic lesions (harmatoma, inflammatory polyps, and mucosal tag). The pit pattern was analyzed for all lesions. Further classification into neoplastic (adenoma and adenocarcinoma) and nonneoplastic (hyperplastic and others) polyps revealed 156 neoplastic and 14 nonneoplastic polyps among the type III to type V pits and 92 nonneoplastic and 8 neoplastic polyps among the type I and II pits. The sensitivity of type III to type V pits in detecting neoplastic polyps was 95.1%, with a specificity of 86.8% and diagnostic accuracy of 91.9%. The positive likelihood ratio was 7.3, and the negative likelihood ratio was 0.06. Magnifying colonoscopy with indigo carmine dye contrast provides morphological detail that correlates well with polyp histology. Small flat lesions with typical type II pit pattern should have minimal neoplastic risk, thus endoscopic resection is not necessary.     

Magnifying colonoscopy in differentiating neoplastic from nonneoplastic colorectal lesions

OBJECTIVE: Because the medical management of persons with adenomatous colorectal polyps differs from that of those with hyperplastic polyps, accuracy of diagnosis is essential. This study reports our experience using a magnifying colonoscope combined with indigocarmine dye to diagnose colorectal polyps, emphasizing its ability to differentiate neoplastic from nonneoplastic lesions. METHODS: The materials consisted of 175 polyps. A 0.2% indigocarmine solution was sprayed, and the colonoscope zoom apparatus performed a magnified observation after an ordinary colonoscopy identified the lesions. The pit patterns were classified into six categories: I, II, III(L), IIIs, IV, and V according to Kudo's modified classification. RESULTS: The percentages of neoplastic changes in the lesions with pit pattern I, II, III(L), IIIs, IV, and V were 0, 12.2, 69.7, 80, 84.4, and 100%, respectively. The diagnostic sensitivity of neoplastic lesions was 93.8% and specificity was 64.6% when types I and II represented the pit pattern of nonneoplastic lesions and types III(L), IIIs, IV, and V represented neoplastic lesions. The overall diagnostic accuracy in differentiating neoplastic from nonneoplastic lesions was 80.1%. The diagnostic accuracy is not influenced by the size and shape of the lesions. The six neoplastic lesions that were misjudged to be nonneoplastic were histologically adenoma with only mild atypia. CONCLUSIONS: The pit pattern analysis of colorectal lesions by magnifying colonoscopy is a useful and objective tool for differentiating neoplastic from nonneoplastic lesions of the large bowel. In its current state of development, however, this technique is not a substitute for histology.     

Computed virtual chromoendoscopy for classification of small colorectal lesions: a prospective comparative study

OBJECTIVES: Standard colonoscopy offers no reliable discrimination between neoplastic and nonneoplastic colorectal lesions. Computed virtual chromoendoscopy with the Fujinon intelligent color enhancement (FICE) system is a new dyeless imaging technique that enhances mucosal and vascular patterns. This prospective trial compared the feasibility of FICE, standard colonoscopy, and conventional chromoendoscopy with indigo carmine in low- and high-magnification modes for determination of colonic lesion histology. METHODS: Sixty-three patients with 150 flat or sessile lesions less than 20 mm in diameter were enrolled. At colonoscopy, each lesion was observed with six different endoscopic modalities: standard colonoscopy, FICE, and conventional chromoendoscopy with indigo carmine (0.2%) dye spraying in both low- and high-magnification modes. Histopathology of all lesions was confirmed by evaluation of endoscopic resection or biopsy specimens. Endoscopic images were stored electronically and randomly allocated to a blinded reader. RESULTS: Of the 150 polyps, 89 were adenomas and 61 were hyperplastic polyps with an average size of 7 mm. For identifying adenomas, the FICE system with low and high magnifications revealed a sensitivity of 89.9% and 96.6%, specificity of 73.8% and 80.3%, and diagnostic accuracy of 83% and 90%, respectively. Compared with standard colonoscopy, the sensitivity and diagnostic accuracy achieved by FICE were significantly better under both low (P < 0.02) and high (P < 0.03) magnification and were comparable to that of conventional chromoendoscopy. CONCLUSIONS: The FICE system identified morphological details that efficiently predict adenomatous histology. For distinguishing neoplastic from nonneoplastic lesions, FICE was superior to standard colonoscopy and equivalent to conventional chromoendoscopy.     

窄带成像技术在大肠肿瘤性病变与非肿瘤性病变的鉴别诊断中的价值

目的探讨窄带成像技术(narrow band imaging,NBI)在大肠肿瘤性病变与非肿瘤性病变的鉴别诊断中的价值。方法收集2010年1月-2013年10月在梧州红十字会医院内镜室进行结肠镜检查的患者98例,通过普通肠镜、NBI检查结果与病理学检查结果进行对比分析,鉴别诊断大肠肿瘤性病变与非肿瘤性病变。结果 98例患者中共发现136个病变。普通内镜诊断肿瘤性病变的敏感性、特异性及准确性分别为75.5%、78.6%及76.5%;NBI诊断肿瘤性病变的敏感性、特异性及准确性分别为95.7%、95.2%及95.6%,后者明显高于前者,差异有统计学意义(P0.01)。病变轮廓、pit及CP显示清晰度比较,NBI明显优于普通内镜,差异均有统计学意义(P0.01)。结论相对于普通内镜,NBI内镜能更清晰地显示病变的轮廓、腺管开口的分型及微血管的形态,在大肠肿瘤性病变与非肿瘤性病变的鉴别诊断中有重要价值。     

Comparison of magnified pit pattern interpretation with narrow band imaging versus chromoendoscopy for diminutive colonic polyps: a pilot study

BACKGROUND: Chromoendoscopy can accurately differentiate neoplastic from nonneoplastic polyps in the colon. Narrow band imaging (NBI) has been described as "electronic chromoendoscopy," but it is unclear whether pit patterns seen with chromoendoscopy are identical to those with NBI. OBJECTIVE: Pilot study to compare features of diminutive polyps assessed with magnification NBI and chromoendoscopy. DESIGN: Prospective polyp series. SETTING: Single tertiary referral center in the United Kingdom. PATIENTS: Twenty patients seen for routine colonoscopy. INTERVENTION: Digital images of each polyp recorded with NBI and chromoendoscopy were subsequently assessed as single images in a random order and as paired polyp images by experienced European- and Japanese-trained endoscopists. MAIN OUTCOME MEASUREMENTS: Pit pattern (Kudo classification); vascular pattern intensity (weak, normal, strong); predicted histology; pit pattern and vessel network clarity (scale 1-3, 1 poor, 3 excellent). RESULTS: A total of 33 polyps 相似文献   

Magnifying colonoscopy as a non-biopsy technique for differential diagnosis of non-neoplastic and neoplastic lesions

AIM: To clarify whether mucosal crypt patterns observed with magnifying colonoscopy are feasible to distinguish non-neoplastic polyps from neoplastic polyps. METHODS: From June 1999 through March 2000, 180 consecutive patients with 210 lesions diagnosed with a magnifying colonoscope (CF-200Z, Olympus Optical Co., Ltd., Tokyo, Japan) were enrolled. Magnification and chromoendoscopy with 0.2% indigo-carmine dye was applied to each lesion for mucosal crypt observation. Lesions showing typesⅠandⅡcrypt patterns were considered non-neoplastic and examined histologically by biopsy, whereas lesions showing typesⅢtoⅤcrypt patterns were removed endoscopically or surgically. The correlation of endoscopic diagnosis and histologic diagnosis was then investigated. RESULTS: At endoscopy, 24 lesions showed a typeⅠorⅡpit pattern, and 186 lesions showed typeⅢtoⅤpit patterns. With histologic examination, 26 lesions were diagnosed as non-neoplastic polyps, and 184 lesions were diagnosed as neoplastic polyps. The overall diagnostic accuracy was 99.1% (208/210). The sensitivity and specificity were 92.3% (24/26) and 99.8% (184/186), respectively. CONCLUSION: Magnifying colonoscopy could be used as a non-biopsy technique for differentiating neoplastic and non-neoplastic polyps.     

利用窄带成像技术观察毛细血管形态在结直肠息肉样病变鉴别诊断中的价值

目的:探讨利用窄带成像技术(narrow bandimaging,NBI)观察毛细血管形态(capillarypatterns,CP)对结直肠息肉样病变鉴别诊断的价值.方法:75例患者接受NBI结肠镜检查共发现病变部位116处.根据Yoshiki的分型方法,将结直肠病变的CP分为6种:蜂窝状结构型、模糊结构型、网状结构型、密度增高型、不规则结构型、稀疏结构型.利用NBI下观察到的CP进行鉴别诊断,并与病理结果对照判定其敏感性、特异性及准确率.结果:在116例结直肠病变中增生性息肉毛细血管形态多表现为模糊结构型,而腺瘤性息肉的毛细血管形态表现为网状结构型和密度增高型,癌症的毛细血管形态多表现为不规则型和稀疏结构型.利用此分型方法鉴别肿瘤性病变和非肿瘤性病变的敏感性和特异性分别是94.6%和78.6%,准确性88.8%,阳性预测值(positive predictive value,PPV)88.6%,阴性预测值(negative predictivevalue,NPV)89.2%(P<0.01).同样,对于腺瘤性息肉和癌症的鉴别诊断的敏感性和特异性分别是100.0%和87.5%,准确性91.4%(P<0.01).将直径<10 mm的小息肉按毛细血管的有无进行鉴别诊断的敏感性和特异性分别是89.7%和80.5%,PPV81.4%,NPV89.2%,准确性85.0%(P<0.01).结论:NBI结肠镜观察结直肠病变CP对于鉴别肿瘤性病变与非肿瘤性病变,以及腺瘤性息肉与癌症具有可靠的诊断价值.对于直径<10 m m小息肉的肿瘤性及非肿瘤性的鉴别诊断方面NBI结肠镜也具有很好作用.     

A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia

BACKGROUND: Discrimination between neoplastic and non-neoplastic lesions is crucial in colorectal cancer screening. Application of narrow-band imaging (NBI) in colonoscopy visualises mucosal vascular networks in neoplastic lesions and may improve diagnostic accuracy. AIM: To compare the diagnostic efficacy of NBI in differentiating neoplastic from non-neoplastic colorectal lesions with diagnostic efficacies of standard modalities, conventional colonoscopy, and chromoendoscopy. METHODS: In this prospective study, 180 colorectal lesions from 133 patients were observed with conventional colonoscopy, and under low-magnification and high-magnification NBI and chromoendoscopy. Lesions were resected for histopathological analysis. Endoscopic images were stored electronically and randomly allocated to two readers for evaluation. Sensitivity, specificity and diagnostic accuracy of each endoscopic modality were assessed by reference to histopathology. RESULTS: NBI and chromoendoscopy scored better under high magnification than under low magnification in comparison with conventional colonoscopy. The diagnostic accuracy of NBI with low or high magnification was significantly higher than that of conventional colonoscopy (low magnification: p = 0.0434 for reader 1 and p = 0.004 for reader 2; high magnification: p<0.001 for both readers) and was comparable to that of chromoendoscopy. CONCLUSION: Both low-magnification and high-magnification NBI were capable of distinguishing neoplastic from non-neoplastic colorectal lesions; the diagnostic accuracy of NBI was better than that of conventional colonoscopy and equivalent to that of chromoendoscopy. The role of NBI in screening colonoscopy needs further evaluation.     

内镜窄带成像与染色技术诊断大肠肿瘤的对比研究

目的通过窄带成像技术（NBI）和染色放大方法对大肠新生性病变进行观察，比较这两种技术对大肠肿瘤及非肿瘤性病变的鉴别诊断精度差异。方法2006年6月至9月间，共302例年龄在加至80岁之间的患者进行了NBI肠镜检查，其中98例入选。内镜插入至回盲部，退镜时分别采用常规模式、NBI模式观察，发现病变后，分别用NBI模式及染色放大方法进行血管分型及腺管开口分型，然后行病理检查进行评价比较。结果在98例患者发现新生性病变147个，其中常规内镜下发现的病变有90．5％（133／147），采用NBI发现病变有98．6％（145／147），差异有统计学意义（P〈0．01），漏诊的主要为平坦型病变。NBI观察对肿瘤性或非肿瘤的判断符合率为91．8％，染色内镜为82．3％（P〈0.01）。结论NBI技术观察黏膜表面变化，判断肿瘤或非肿瘤病变的符合率比普通内镜和染色内镜高，敏感性强；操作转换简单易行，尤其有利于平坦型病变的发现及诊断。     

内镜窄带成像技术在结肠肿瘤诊断中的价值

目的 将内镜窄带成像技术（NBI）、色素内镜检查结果与病理学检查结果进行对比,探讨NBI在结肠肿瘤诊断中的价值。方法78例患者96个结肠病变进行NBI放大观察并与染色放大内镜观察和最终病理结果进行比较。结果普通肠镜发现息肉的敏感性为78．7％,切换NBI后,能清楚显示息肉性病变的形态和边界,发现息肉的敏感性99％。放大NBI肠镜对于Ⅱ型,Ⅲ1型,Ⅳ型,ⅤN型息肉腺管开口的图像与色素内镜图像有较好的相似性,NBI对于腺管开口的识别能力明显优于普通结肠镜,但是次于色素内镜。NBI对息肉表面血管形态进行分类对判断结肠是否有肿瘤的能力,其敏感性为100％,特异性为87．8％,同样明显优于普通结肠镜,而次于色素内镜。结论NBI肠镜及色素内镜均能提高发现结肠息肉的特异性、敏感性。色素内镜能清晰显示病变表面结构和腺管开口,使内镜下对于肿瘤与非肿瘤的鉴别诊断接近病理诊断。NBI放大肠镜能清晰显示息肉表面的毛细血管形态,较好地区分肿瘤与非肿瘤。NBI内镜切换简单快捷,便于全结肠观察,利于发现早期结肠肿瘤。     

Comparative study of conventional colonoscopy, magnifying chromoendoscopy, and magnifying narrow-band imaging systems in the differential diagnosis of small colonic polyps between trainee and experienced endoscopist

Background  

Removal of colorectal neoplastic polyps can reduce the incidence of colorectal cancers. It is important to distinguish neoplastic from nonneoplastic polyps. We compared the ability of a trainee and an experienced endoscopist in distinguishing between neoplastic polyps and nonneoplastic polyps by conventional white-light, magnifying narrow-band imaging (NBI), and magnifying chromoendoscopy.     

Accuracy of high-resolution chromoendoscopy in prediction of histologic findings in diminutive lesions of the rectosigmoid

BACKGROUND: The ability to differentiate adenomatous from nonadenomatous colonic polyps by using chromoendoscopy would obviate the need to remove hyperplastic lesions. The aim of this study was to define the accuracy of high-resolution chromoendoscopy for the determination of colonic polyp histology. METHODS: In 158 patients, 273 polyps (<5 mm) in the rectosigmoid were estimated for their histology. The endoscopists, in two steps, predicted the histopathology of each lesion on the basis of its surface characteristics by using high-resolution colonoscope without any staining and after indigo carmine dye according to the Kudo classification. RESULTS: The resected polyps included 48 adenomatous and 225 nonadenomatous polyps. When histologically confirmed hyperplastic polyps were compared with adenomatous polyps, the prediction of hyperplastic polyps based on endoscopic findings had a sensitivity of 93%, a specificity of 60%, and an overall accuracy of 81%. The corresponding sensitivity, specificity, and overall accuracy after indigo carmine dye were 94%, 64%, and 83%, respectively. CONCLUSIONS: The results suggest that the chromoendoscopy only marginally improves the determination between hyperplastic and adenomatous polyps when using high-resolution colonoscopes. The overall accuracy rate increased after dyeing, from 81% to 83%. The omission of histopathologic analysis cannot yet be achieved by chromoendoscopy.     

普通窄带成像内镜对结直肠增生性息肉和腺瘤的鉴别诊断价值

目的 分析普通窄带成像(NBI)内镜下结直肠增生性息肉与腺瘤腺管及微血管特征的差异,评价NBI的鉴别诊断价值.方法 将普通内镜下诊断结直肠息肉、病理检查证实为增生性息肉或腺瘤者纳入研究并进行NBI内镜检查.将腺管形态参照改良的工藤分型法分为A型和B型.将微血管形态分为3型,无微血管判为Ⅰ型,微血管沿腺管开口排列、粗细均匀判为Ⅱ型,微血管粗细不均、排列紊乱判为Ⅲ型.比较增生性息肉和腺瘤NBI图像中腺管形态和微血管形态特征的差异,同时对无放大NBI图像观察者间的一致性进行评价.结果 共87例患者的107个息肉(腺瘤73个、增生性息肉34个)进行普通NBI内镜检查.腺瘤组息肉最大径和表面分叶者比例明显高于增生性息肉组(P值分别=0.0023和0.0047).腺瘤组中B型腺管形态[86.3％(63/73)]及Ⅱ或Ⅲ型微血管形态[82.2％(60/73)]者较多.以B型腺管形态、Ⅱ型或Ⅲ型微血管中任一特征诊断腺瘤的敏感度、特异度、准确率分别为97.3％、82.4％、92.5％.以B型腺管形态联合Ⅱ型或Ⅲ型微血管诊断腺瘤的敏感度、特异度、准确率分别为71.2％、91.2％、77.6％.观察者间一致性评价平均Kappa值为0.761.结论 普通NBI内镜下结直肠腺瘤和增生性息肉的微血管特征和腺管特征存在差异,依据以上两方面可在NBI内镜下实时初步鉴别腺瘤和增生性息肉.     

Reduction of miss rates of colonic adenomas by zoom chromoendoscopy

Background and aims The aim of this study was to determine the detection rate of polyps using zoom chromoendoscopy (ZE) compared with standard video colonoscopy.Patients and methods End-to-end colonoscopies were performed in 50 patients by two different endoscopists blinded for each other’s results. Lesions detected during initial standard colonoscopy (C1) were biopsied or removed by snare resection. The second colonoscopy (C2) was done with a zoom colonoscope spraying the whole colon with indigocarmine (0.4%). In addition, detected mucosal lesions were documented prior to ZE and then classified according to the pit pattern classification before biopsy or removal. The retrieval time for each procedure was determined. Results: The average retrieval time for C1 was 13±9 min (9–24) and 28±11 min (16–38, p<0.05) for ZE. During C1, 56 lesions were detected in 26 of 50 patients (34 hyperplastic and 22 adenomatous). During C2, 19 additional polyps were documented prior to ZE (15% tandem miss rate), and 20 further lesions were detected with ZE (21% additional polyp detection rate compared to C1 and C2 without ZE). Of the 39 additional lesions removed during C2 after ZE, 29 were hyperplastic and 10 were adenomatous. Most adenomas detected during the second investigation were found in patients in whom adenomatous polyps had already been removed during the initial colonoscopy (9 of 26 patients vs 1 of 24 patients, p<0.02). No carcinoma was detected. The pit pattern classification allowed a correct differentiation between hyperplastic and adenomatous polyps (accuracy 93%, sensitivity 90%, specificity 97%).Conclusion Using zoom chromoendoscopy, the rate of detecting colonic polyps can be increased at the cost of a longer retrieval time.     

窄带成像结肠镜对结肠息肉样病变的诊断价值

探讨窄带成像（NBI）结肠镜对结肠息肉样病变的病理组织类型的预测能力.方法 125例患者接受结肠镜检查诊断结肠息肉样病变173个,根据腺管开口形态及NBI下血管分型判定该病变为肿瘤性病变（结肠腺瘤、结肠癌）或非肿瘤性病变,并与病理结果对照,判定各种方法的敏感性、特异性及准确率.结果 NBI下血管形态鉴别肿瘤性或非肿瘤性病变的敏感性、特异性及准确率（94.83%、91.23%、93.64%）以及隐窝形态结合血管形态鉴别肿瘤性或非肿瘤性病变的敏感性、特异性及准确率（95.69%、96.49%、95.59%）显著高于常规内镜（80.17%、84.21%、81.50%）（P〈0.05）.血管形态鉴别腺瘤与结肠癌的敏感性、特异性、准确率为86.90%、100.00%、87.93%.结论 NBI模式下结肠镜检查对息肉样病变的肿瘤性、非肿瘤性,结肠腺瘤、结肠癌的鉴别优于常规内镜检查,接近病理学检查.     

黏膜表面形态特点对大肠息肉病理类型的预判价值

目的在高清非放大结肠镜下观察大肠息肉表面形态特点,与病理组织学诊断进行对照研究,评价息肉黏膜表面形态特点对大肠息肉病理类型的预判能力。方法对142例结直肠息肉患者330枚息肉样病变进行高清结肠镜检查并观察黏膜腺管开口形态,采用窄波带成像技术(narrow band imaging,NBI)观察黏膜表面血管形态(capillary pattern,CP),与息肉病理结果对照判定其敏感性、特异性及准确率。结果高清非放大结肠镜下联合黏膜腺管开口形态及黏膜表面血管形态判定息肉表面形态特点对鉴别肿瘤性与非肿瘤性病变的敏感性为88.2%,特异性为83.6%,阳性预测值为95.5%,阴性预测值为64.4%,准确度为87.3%,阳性相似比为5.4,阴性相似比为0.1。结论高清非放大结肠镜下贴近观察结合NBI显像观察息肉表面形态对于鉴别大肠息肉是否为肿瘤性有重要价值,与病理诊断有较好的符合率,有助于决定进一步治疗及随访方案。     

高清不放大窄带成像内镜对大肠隆起性病变的鉴别诊断作用

目的评价窄带成像技术(NBI)普通内镜在大肠隆起样病变诊断中价值。方法应用NBI普通内镜观察了80例患者共103个大肠隆起样病变的表面腺管开口形态。根据工藤进英腺管开口形态分型法,将NBI内镜诊断结果与病理检查结果进行比较。结果普通肠镜发现隆起样病变的敏感性为80.0%(80/103),切换NBI后,能清楚显示隆起样病变的形态和边界,发现隆起样病变的敏感性为100%(103/103);NBI普通内镜观察隆起样病变腺管开口,根据工藤进英腺管开口形态分型法进行诊断,其中腺管开口呈Ⅱ型18例,Ⅲ(L)型54例,Ⅳ型15例,Ⅴ型16例。NBI普通内镜对于大肠隆起性病变肿瘤及非肿瘤性的鉴别诊断的敏感性、特异性分别为95.3%(81/85)、83.3%(15/18)、NBI普通内镜对于大肠隆起性病变肿瘤及非肿瘤性的鉴别诊断的符合率为93.2%(96/103),与文献报道的NBI放大内镜的94.1%无统计学差异(P0.05)。结论应用NBI普通内镜,也可以通过观察腺管开口形态,比较准确地鉴别诊断大肠肿瘤与非肿瘤病变。     

Time saving with narrow-band imaging for distinguishing between neoplastic and non-neoplastic small colorectal lesions

Background and Aims: For colonoscopic examinations, the narrow‐band imaging (NBI) system is more convenient and timesaving than magnifying chromoendoscopy (MCE). However, the time‐saving aspects of NBI techniques have not been assessed. The present study compared interpretation times between NBI and MCE techniques in distinguishing between neoplastic and non‐neoplastic small colorectal lesions. Methods: Between January and March 2010, 693 consecutive patients who underwent colonoscopy at the National Cancer Center Hospital, Tokyo, Japan, were enrolled. When the first lesion was detected by conventional white‐light observation, the patient was randomly assigned to undergo a sequence of NBI and MCE observations (group A: NBI–MCE, group B: MCE–NBI). The time to diagnosis with each modality (NBI, from changing to NBI until diagnosis; MCE, from the start of indigo carmine solution spraying until diagnosis) was recorded by an independent observer. The sensitivity, specificity, and diagnostic accuracy of the first modality used in each group (NBI or MCE) were assessed by referring to the histopathological data. Results: Seventy‐one patients with 137 lesions were randomized to group A, and 80 patients with 163 lesions to group B. The median interpretation times were 12 s (interquartile range [IQR]: 7–19 s) in group A, and 17 s (IQR: 12–24 s) in group B, the difference being significant (P < 0.001). No significant differences were observed between NBI and MCE in terms of sensitivity, specificity, and diagnostic accuracy. Conclusions: NBI reduces the interpretation times for distinguishing between neoplastic and non‐neoplastic small lesions during colonoscopies, without loss of diagnostic accuracy.     

Conventional colonoscopy and magnified chromoendoscopy for the endoscopic histological prediction of diminutive colorectal polyps： A single operator study

AIM: To accurately differentiate the adenomatous from the non-adenomatous polyps by colonoscopy. METHODS: All lesions detected by colonoscopy were first diagnosed using the conventional view followed by chromoendoscopy with magnification. The diagnosis at each step was recorded consecutively. All polyps were completely removed endoscopically for histological evaluation. The accuracy rate of each type of endoscopic diagnosis was evaluated, using histological findings as gold standard. RESULTS: A total of 240 lesions were identified, of which 158 (65.8%) were non-neoplastic and 82 (34.2%) were adenomatous. The overall diagnostic accuracy of conventional view, and chromoendoscopy with magnification was 76.3% (183/240) and 95.4% (229/240), respectively (P< 0.001) CONCLUSION: The combination of colonoscopy and magnified chromoendoscopy is the most reliable non-biopsy method for distinguishing the non-neoplastic from the neoplastic lesions.