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。     

窄带成像技术在结直肠肿瘤性与非肿瘤性病变诊断中的临床应用价值

目的探讨内镜窄带成像技术(NBI)在结直肠肿瘤性及非肿瘤性病变诊断中的临床价值.方法选择2010年2月至2011年3月常规结肠镜检查发现的结直肠肿瘤性与非肿瘤性病变75个(60例).发现病变后分别采用常规模式、NBI模式及染色方法对病变轮廓、黏膜表面腺管开口(PIT)及微血管(CP)形态进行观察,与病理检查结果进行对比...     

窄带成像放大内镜鉴别大肠肿瘤性与非肿瘤性病变的价值

目的 探讨窄带成像放大内镜（NBI—ME）鉴别大肠肿瘤性与非肿瘤性病变表面网状微血管结构改变的临床价值。方法选择常规内镜检出大肠肿瘤性、非肿瘤性病变144处（102例）,记录NBI—ME观察病变表面微血管结构（CP）形态和染色放大内镜观察病变黏膜表面腺管开口（pit）形态。分析pit周围CP形态变化,比较两者形态间的关系。所有病变经内镜或手术治疗后行组织病理学检查。结果常规内镜鉴别病变是否为肿瘤性的准确率75．7％、敏感性85．1％、特异性40．0％,明显低于NBI—ME和染色放大内镜（P〈0．005）,NBI—ME和染色放大内镜间则未见差异。CP分型与pit分型对照,CP—Ⅰ型、Ⅱ型、Ⅳ型、Ⅵa型分别与pitⅠ型、Ⅱ型、Ⅳ型、Ⅴ1型间一致性达100％。144处病变中,内镜治疗129处,手术治疗15处。组织病理学检查：非肿瘤性30处（增生性息肉17处、炎症性息肉13处）;肿瘤性114处（腺瘤95处、腺癌19处）。结论初步显示NBI—ME和染色放大内镜之间具有正相关性,两种检查方法互补可作为当前鉴别大肠病变是否为肿瘤性的重要手段。     

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。     

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。     

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。     

窄带成像技术普通内镜诊断大肠肿瘤的价值

目的探讨窄带成像技术普通内镜（NBI）诊断大肠肿瘤的临床价值。方法 2012年6月至2012年8月行常规内镜和NBI普通内镜检查的患者225例,对发现的大肠新生性病变记录腺管开口形态,将NBI内镜诊断和病理组织学诊断结果进行对比分析,并比较NBI内镜与常规内镜在鉴别肿瘤性和非肿瘤性病变的敏感性、特异性和准确性。结果 NBI普通内镜对腺管开口类型的判断接近病理水平,鉴别病变是否为肿瘤的敏感性、特异性、准确率分别为93.6%,91.7%和93.0%,显著高于常规内镜（P〈0.01）。结论 NBI普通内镜能较准确判断病变的性质,为鉴别是否为肿瘤性病变的更有效的内镜方法。     

窄带成像技术联合超声内镜诊断直肠癌的临床价值分析

目的分析窄带成像技术(narrow band imaging,NBI)联合超声内镜(endoscopic ultrasonography,EUS)诊断直肠癌的临床价值。方法以徐州市中心医院2013年5月-2015年5月收治的66例患者为研究对象,经结肠镜检查均发现直肠息肉样病变,并行病理组织学检查。对比NBI及EUS的诊断效果。结果 66例患者共检出息肉样病变100个,其中39个为增生或炎性息肉,53个为腺瘤,8个为直肠癌。NBI联合EUS观察到的病变轮廓、表面结构、微血管形态的图像清晰度显著高于普通内镜,差异有统计学意义(P0.01)。NBI联合EUS诊断肿瘤性病变的准确率为95.1%(58/61),非肿瘤性为92.3%(36/39)。结论 NBI联合EUS能明确病变形态、解剖关系及分期,对直肠癌的早期诊断具有积极作用,为患者早期治疗策略的制定与实施提供了良好的参考。     

非放大内镜下NICE分型判断结直肠肿瘤性息肉的临床应用价值

目的 评估非放大内镜下窄带成像技术（NBI）国际结直肠内镜分型（NICE分型）系统判断结直肠肿瘤的临床实际应用价值。方法 回顾性纳入普通内镜医师行白光结肠镜检查检出、并行NBI观察及NICE分型的224处结直肠息肉资料,对NICE分型结果和内镜或外科手术切除标本的病理结果进行对比分析。结果 224处息肉中NICE 1型59处,2型159处,3型6处;病理诊断非肿瘤性息肉58处,肿瘤性息肉166处。依据NICE分型诊断肿瘤性息肉的总体敏感度、特异度、阳性预测值、阴性预测值和准确率分别为91.6%、77.6%、92.1%、76.2%和87.9%。NICE分型预测大息肉（直径≥10mm）、小息肉（直径6~9mm）和微小息肉（直径≤5mm）肿瘤性与否的敏感度和准确率分别为100.0%、97.0%、80.9%和95.7%、87.8%、83.3%,诊断准确率随病变直径变小而下降,但差异无统计学意义（P=0.694）。结论 临床实际工作中,普通内镜医师利用非放大内镜下NICE分型判断结直肠肿瘤总体准确率较高,具有一定临床推广应用价值。     

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.     

Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps

AIM: To identify the feasibility of the narrow-band imaging (NBI) method compared with that of conventional colonoscopy and chromoendoscopy for distinguishing neoplastic and nonneoplastic colonic polyps. METHOD: This study enrolled consecutive patients who underwent colonoscopy using a conventional colonoscope between January and February 2006 at Chang-Gung Memorial Hospital, Linkou Medical Center, Taiwan. These 78 patients had 110 colorectal polyps. During the procedure, conventional colonoscopy first detected lesions, and then the NBI system was used to examine the capillary networks. Thereafter indigo carmine (0.2%) was sprayed directly on the mucosa surface prior to evaluating the crypts using a conventional colonoscope. The pit patterns were characterized using the classification system proposed by Kudo. Finally, a polypectomy or biopsy was performed for histological diagnosis. RESULTS: Of the 110 colorectal polyps, 65 were adenomas, 40 were hyperplastic polyps, and five were adenocarcinomas. The NBI system and pit patterns for all lesions were analyzed. For differential diagnosis of neoplastic (adenoma and adenocarcinoma) and nonneoplastic (hyperplastic) polyps, the sensitivity of the conventional colonoscope for detecting neoplastic polyps was 82.9%, specificity was 80.0% and diagnostic accuracy was 81.8%, significantly lower than those achieved with the NBI system (sensitivity 95.7%, specificity 87.5%, accuracy 92.7%) and chromoendoscopy (sensitivity 95.7%, specificity 87.5%, accuracy 92.7%). Therefore, no significant difference existed between the NBI system and chromoendoscopy during differential diagnosis of neoplastic and nonneoplastic polyps. CONCLUSION: The NBI system identified morphological details that correlate well with polyp histology by chromoendoscopy.     

内镜窄带光成像对儿童食管息肉的诊断价值

为探讨内镜窄带光成像技术（narrow?band imaging，NBI）对儿童食管息肉的诊断价值，在白光内镜及NBI内镜下分别对2016年1月—2020年6月上海市儿童医院的35例患儿的食管息肉进行微细形态的观察，以病理检查结果作为金标准，分析和对比白光内镜与NBI内镜诊断息肉的灵敏度及特异度。35例患儿共发现食管息肉70枚，其中27例患儿为单发息肉。病理结果提示息肉以非肿瘤性息肉为多（52.9%，37/70）。NBI内镜诊断肿瘤性息肉的灵敏度［93.9%（31/33）比90.9%（30/33）］和特异度［89.2%（33/37）比78.4%（29/37）］优于传统白光内镜，灵敏度差异有统计学意义（P<0.001），特异度差异无统计学意义（P=0.864）。NBI内镜通过观察食管息肉的微细结构，有助于临床预判息肉的病理性质，其灵敏度优于白光内镜。     

Narrow-band imaging colonoscopy--a pilot feasibility study for the detection of polyps and correlation of surface patterns with polyp histologic diagnosis

BACKGROUND: Colonoscopy is the preferred screening method for colorectal cancer. However, it has a substantial miss rate for colon polyps, and several techniques have been attempted to improve this limitation. Narrow-band imaging (NBI) is a novel technology that enhances the visualization of surface mucosal and vascular patterns. OBJECTIVE: The aim of this study was to determine the detection rate of additional polyps by NBI after removal of polyps visualized by standard white light colonoscopy (WLC) and to correlate the surface mucosal and vascular patterns with polyp histologic diagnosis. DESIGN: This was a prospective pilot feasibility study. SETTING: Kansas City Veterans Affairs Medical Center. PATIENTS: Subjects referred for screening colonoscopy were prospectively enrolled. METHODS: Subjects underwent colonoscopy after enrollment. After intubation of the cecum, colonic segments were sequentially examined, initially with WLC with removal of polyps followed by re-examination of the same segment with NBI. Additional polyps seen with NBI were photographed for their surface patterns and then removed. The total number of polyps visualized by WLC and NBI was calculated and the surface patterns were then correlated with polyp histologic features. RESULTS: Forty patients were enrolled in the study, all men, 32 white. The mean age was 62 years. A total of 72 polyps were detected by WLC (43 tubular adenoma, 28 hyperplastic polyps), whereas NBI detected an additional 51 polyps, of which 29 were tubular adenomas and 22 were hyperplastic. Five different surface/vascular patterns were observed: fine capillary network with absent mucosal pattern, circular pattern with dots, round/oval pattern, tubular pattern, and gyrus pattern. The sensitivity, specificity, and overall accuracy of the first two patterns for hyperplastic polyps were 86%, 96%, and 92%, respectively, and of the latter three patterns for tubular adenomas were 96%, 86%, and 92%, respectively. CONCLUSIONS: This pilot study demonstrates the feasibility of polyp detection and histologic correlation with NBI. These findings need to be confirmed in future randomized controlled trials.     

Colonic polyps diagnosis by conventional video colonoscopes and chromoscopy with indigo carmine dye solution

BACKGROUND: Magnification colonoscopy and contrast chromoscopy with indigo carmine dye solution have been used to differentiate neoplastic polyps (adenomas and adenocarcinomas) from non-neoplastic (hyperplastic, inflammatory, juvenile) in an attempt to obviate endoscopic polypectomy. On the other hand, little published information exists concerning conventional video colonoscopes and chromoscopy for polyp histology prediction. Aim - To assess usefullness of conventional video colonoscopes and contrast chromoscopy with indigo carmine solution for differential diagnosis of colon polyps. METHODS: In a routine colonoscopy series, we performed chromoscopy with conventional video colonoscopes before endoscopic excision of detected polyps. If a sulcus pattern was observed on the surface of the lesion, it was classified as neoplastic. Polyps were classified as non-neoplastic if no sulcus was detected on its surface. These observations were then compared with histology. RESULTS: In the study period (18 months), we detected 133 polyps in 53 patients. We were able to compare results of histology and chromoscopy in 126 lesions. The sensitivity, specificity, diagnostic accuracy, negative predictive value, and positive predictive value were 56,4%, 79,2%, 65,1%, 52,8%, and 81,5%, respectively. CONCLUSION: On the base of the presented data, we concluded that conventional video colonoscopes and contrast chromoscopy with indigo carmine solution is not a good technique for differential diagnosis of colon polyps.     

Efficacy of a novel auto-fluorescence imaging system with computer-assisted color analysis for assessment of colorectal lesions

AIM:To evaluate the efficacy of computer-assisted color analysis of colorectal lesions using a novel auto-fluorescence imaging(AFI)system to distinguish neoplastic lesions from non-neoplastic lesions and to predict the depth of invasion.METHODS:From January 2013 to April 2013,consecutive patients with known polyps greater than 5 mm in size who were scheduled to undergo endoscopic treatment at The Jikei University Hospital were prospectively recruited for this study.All lesions were evaluated using a novel AFI system,and color-tone sampling was performed in a region of interest determined from narrow band imaging or from chromoendoscopy findings without magnification.The green/red(G/R)ratio for each lesion on the AFI images was calculated automatically using a computer-assisted color analysis system that permits real-time color analysis during endoscopic procedures.RESULTS:A total of 88 patients with 163 lesions were enrolled in this study.There were significant differences in the G/R ratios of hyperplastic polyps(non-neoplastic lesions),adenoma/intramucosal cancer/submucosal(SM)superficial cancer,and SM deep cancer(P<0.0001).The mean±SD G/R ratios were 0.984±0.118in hyperplastic polyps and 0.827±0.081 in neoplastic lesions.The G/R ratios of hyperplastic polyps were significantly higher than those of neoplastic lesions(P<0.001).When a G/R ratio cut-off value of>0.89 was applied to determine non-neoplastic lesions,the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy were 83.9%,82.6%,53.1%,95.6%and 82.8%,respectively.For neoplastic lesions,the mean G/R ratio was 0.834±0.080 in adenoma/intramucosal cancer/SM superficial cancer and 0.746±0.045 in SM deep cancer.The G/R ratio of adenoma/intramucosal cancer/SM superficial cancer was significantly higher than that of SM deep cancer(P<0.01).When a G/R ratio cut-off value of<0.77 was applied to distinguish SM deep cancers,the sensitivity,specificity,PPV,NPV,and accuracy were80.0%,84.4%,29.6%,98.1%and 84     

Multicenter randomised controlled trial comparing the high definition white light endoscopy and the bright narrow band imaging for colon polyps

AIM To compare high definition white light endoscopy and bright narrow band imaging for colon polyps' detection rates. METHODS Patients were randomised to high definition white light endoscopy(HD-WLE) or the bright narrow band imaging(b NBI) during withdrawal of the colonoscope. Polyps identified in either mode were characterised using b NBI with dual focus(b NBI-DF) according to the Sano's classification. The primary outcome was to compare adenoma detection rates(ADRs) between the two arms. The secondary outcome was to assess the negative predictive value(NPV) in differentiating adenomas from hyperplastic polyps for diminutive rectosigmoid lesions.RESULTS A total of 1006 patients were randomised to HD-WLE(n = 511) or b NBI(n = 495). The mean of adenoma per patient was 1.62 and 1.84, respectively. The ADRs in b NBI and HD-WLE group were 37.4% and 39.3%, respectively. When adjusted for withdrawal time(OR = 1.19, 95%CI: 1.15-1.24, P 0.001), the use of b NBI was associated with a reduced ADR(OR = 0.69, 95%CI: 0.52-0.92). Nine hundred and thirty three polyps(86%) in both arms were predicted with high confidence. The sensitivity(Sn), specificity(Sp), positive predictive value and NPV in differentiating adenomatous from non-adenomatous polyps of all sizes were 95.9%, 87.2%, 94.0% and 91.1% respectively. The NPV in differentiating an adenoma from hyperplastic polyp using b NBI-DF for diminutive rectal polyps was 91.0%.CONCLUSION ADRs did not differ between b NBI and HD-WLE, however HD-WLE had higher ADR after adjustment of withdrawal time. b NBI surpassed the PIVI threshold for diminutive polyps.     

The detection of surface patterns by flexible spectral imaging color enhancement without magnification for diagnosis of colorectal polyps

Purpose

Flexible spectral imaging color enhancement (FICE), or image-enhanced endoscopy, can enhance visualization of surface and vascular patterns of colorectal polyps. Resolution of FICE has recently been improved. We evaluated diagnostic accuracy for neoplastic and non-neoplastic colorectal polyp differentiation with detection of surface patterns by FICE without magnification.

Methods

Retrospective analysis of 151 colorectal polyps evaluated by FICE without magnification was performed. Neoplastic surface patterns were defined as tubular and oval pit. We aimed to determine sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy in correlating diagnosis by FICE without magnification with histology. Moreover, findings were compared to those of white-light endoscopy (WL) and chromoendoscopy (CHR).

Results

Of the 151 colorectal polyps, 95 were identified as neoplastic and 56 were identified as non-neoplastic. FICE without magnification had a sensitivity of 89.4%, specificity of 89.2%, PPV of 93.4%, NPV of 83.3%, and accuracy of 89.4%. The accuracy of FICE value was higher than that of WL (sensitivity of 74.7%, specificity of 73.2%, PPV of 82.5%, NPV of 63.0%, and accuracy of 74.1%) and was worse than that of CHR (sensitivity of 96.8%, specificity of 89.2%, PPV of 93.9%, NPV of 96.1%, and accuracy of 94.7%). Imaging evaluation was validated by inter-/intra-observer measurements, demonstrating consistent results.

Conclusions

The detection of surface patterns by FICE without magnification is useful for differential diagnosis of colorectal polyps. We believe that FICE without magnification is more convenient and easier method than CHR.     

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.