色素内镜在电子结肠镜中应用价值研究

目的:结肠镜下应用色染料或色素可增强病变的定位和特征,有利于发现早期结肠肿瘤,且对于内镜下治疗有帮助,采用普通和放大内镜结合染色对于结病变的发现和性质诊断与病理结果进行对照,评价色素内镜的临床价值。方法:对2007年1月至7月在内镜中心拟作内镜下息肉切除的病例81例,117个息肉,分别采用普通结肠镜和放大镜下结合结合0·4%靛胭脂染色采用按工藤分类法进行分类,预测其病理类型,对于不能分类者再采用0·2%甲酚紫染色进行分类,然后行息肉电切后全部送病理活检,将病理结果与内镜下预测对比,分析色素内镜的临床价值。结果:普通电子镜采用靛兰胭脂红染色后所有息肉清晰显示其形态和边界,明显优于染色前。放大肠镜靛胭脂染色对64例87个息肉按工藤分类法进行分类,17例30个息肉靛兰胭脂红染色无法分类,采用0·2%的甲酚紫染色分类,其中Ⅰ型11个,Ⅱ型27个,Ⅲ型46个,Ⅳ型25个,Ⅴ型8例。与病理结果对比,息肉表面腺管开口为Ⅰ、Ⅱ型的的38例病变中全部为增生性息肉,Ⅲ型46个中ⅢL1型33个,管状腺瘤28个,管状绒毛腺瘤5个,ⅢL2型13个,管状腺瘤11个,管状绒毛腺瘤2个,本组未发现现Ⅲs型息肉。Ⅳ型25个中绒毛管状腺瘤15个,绒毛腺瘤8个,灶性癌变2个。Ⅴ型8例,Ⅴ1型3个,ⅤN型5均为腺癌。普通电子肠镜结合色素内镜发现息肉的能力优于普通电子肠镜,对于表面腺管开口的识别靛胭脂染色对ⅢL型,Ⅳ型,Ⅴ型腺管开口有较好的识别能力,明显优于普通电子肠镜,但是对于Ⅰ型、Ⅱ型的鉴别能力差。染色结合放大镜能较好地区分各型,腺管开口的类型对于肿瘤与非肿瘤的鉴别与病理类型有良好的一致性。结论:①普通肠镜结合色素内镜能提高发现结肠息肉敏感性,对于早其肿瘤的诊断与鉴别诊断有价值。②放大肠镜结合色素内镜能清晰显示病变表面结构和腺管开口,对于肿瘤与非肿瘤的鉴别诊断接近病理诊断,对于早期癌的发现有很高的价值,值得更进一步研究与推广应用。     

Chromoendoscopy using indigo carmine dye spraying with magnifying observation is the most reliable method for differential diagnosis between non-neoplastic and neoplastic colorectal lesions: a prospective study

BACKGROUND AND AIMS: Differential diagnosis between non-neoplastic and neoplastic lesions is very important at colonoscopy, since removal or biopsy of non-neoplastic polyps wastes time and resources. We therefore conducted a prospective study to examine whether indigo carmine dye spraying with and without magnification is more reliable than the conventional method for differential diagnosis. PATIENTS AND METHODS: 122 patients with 206 lesions of 10 mm or smaller were recruited into this study. All lesions detected on colonoscopy were first diagnosed using the conventional view, then at chromoendoscopy using 0.2 % indigo carmine, and finally at chromoendoscopy with magnification. The diagnosis at each step were recorded consecutively. All lesions were finally categorized as neoplastic or non-neoplastic according to pit pattern; non-neoplastic lesions were biopsied for histological evaluation, and all the neoplastic ones were removed endoscopically. The accuracy rate of each type of endoscopic diagnosis was evaluated, using histological findings as reference. RESULTS: Histologically, 46 lesions (22 %) were non-neoplastic and 160 (78 %) were neoplastic. The overall diagnostic accuracies by conventional view, chromoendoscopy, and chromoendoscopy with magnification were 84.0 % (173/206), 89.3 % (184/206) and 95.6 % (197/206), respectively. CONCLUSION: Chromoendoscopy with magnification is the most reliable method for determining whether a colorectal lesion is non-neoplastic or neoplastic.     

普通内镜结合靛胭脂染色在鉴别瘤性与非瘤性大肠息肉中的价值

目的探讨普通内镜结合靛胭脂染色在鉴别瘤性与非瘤性大肠息肉中的价值。方法对124个大肠息肉分别行普通内镜及靛胭脂染色内镜诊断,若息肉表面呈沟槽状、脑回状或分叶状结构则定义为瘤性息肉,若表面光滑或有规则小圆点状小凹就定义为非瘤性息肉,并与组织学结果比较,比较2种内镜诊断方法鉴别瘤性与非瘤性大肠息肉的诊断准确率、特异性和敏感性。结果靛胭脂染色内镜鉴别瘤性与非瘤性大肠息肉的诊断准确率显著高于普通内镜(85.48% vs 70.16%,P<0.005)。染色内镜鉴别瘤性与非瘤性大肠息肉的敏感性和特异性分别为86.11%、84.62%,显著高于普通内镜的72.22%、67.31%(P<0.05)。结论普通内镜结合靛胭脂染色可较准确地鉴别瘤性与非瘤性大肠息肉,有助于实时指导内镜下对大肠息肉的处理方式。     

内镜智能分光比色技术诊断结肠肿瘤性病变的临床研究

目的探讨内镜智能分光比色技术（FICE）在诊断结肠肿瘤性病变的价值。方法选择2009年1月至2010年2月期间共781例患者进行常规内镜检查,其中发现结肠新生物或息肉样病变者共236例入选。分别采用常规放大技术、FICE放大技术及染色放大技术对病变进行腺管开口分型及微血管形态观察,对病变作出诊断,并与病理组织学诊断相比较。结果在236例患者中发现新生性病变431个,其中常规放大内镜下发现病变392个（91．0％）,FICE放大模式下发现病变FICE放大内镜发现病变421个（97．9％）,二者比较差异有统计学意义。FICE放大内镜比染色放大内镜更能清晰显示黏膜微血管结构形态（P〈0．01）,在显示腺管开口方面两者差异无统计学意义。FICE放大内镜对肿瘤性及非肿瘤性判断符合率为符合率90．7％,高于染色放大内镜82．3％（P〈0．01）。结论FICE放大内镜可以观察黏膜表面微细结构及微血管形态,对结肠肿瘤性及非肿瘤性病变诊断的符合率高于普通放大内镜及染色放大内镜,有利于结肠早期癌的发现,有良好的I临床应用价值。     

内镜智能分光比色技术对大肠息肉的诊断价值

目的探讨内镜智能分光比色技术（FICE）对结肠息肉的诊断价值。方法选择2009年3月至2010年1月进行常规结肠镜检查发现结肠息肉样病变者共197例。分别采用常规放大技术、FICE放大技术及染色放大技术对结肠息肉进行腺管开口分型及微血管形态观察,并与病理组织学诊断相比较。结果在197例患者中发现息肉样病变359个,其中常规放大内镜下发现息肉327个（91．2％）,FICE放大内镜发现息肉351个（97．8％）,二者比较差异有统计学意义。FICE放大内镜比染色放大内镜更能清晰显示黏膜微血管结构形态（P〈0．01）,在显示腺管开口方面两者无统计学意义。FICE放大内镜对瘤性息肉及非瘤性息肉判断符合率为90．3％,高于染色放大内镜82．5％（P〈0．01）。结论FICE放大内镜可以观察黏膜表面微细结构及微血管形态,对结肠瘤性息肉及非瘤性息肉诊断的符合率高于普通放大内镜及染色放大内镜,有利于结肠早期癌的发现,有良好的临床应用价值。     

染色结肠镜和染色放大结肠镜在结直肠隆起性黏膜病变中临床应用价值的研究

目的 探讨普通结肠镜、染色结肠镜、染色放大结肠镜在结直肠隆起性黏膜病变中临床应用价值。方法 对30例结肠镜检查发现黏膜隆起性病变的病人，先作普通结肠镜诊断，再作染色结肠镜诊断，最后用放大结肠镜作出诊断。所有病变作病理学检查。将普通结肠镜、染色结肠镜、染色放大结肠镜的诊断结果与病理学诊断结果进行比较分析。结果 共发现64个隆起性黏膜病变，普通结肠镜诊断为炎性息肉、管状腺瘤、绒毛状腺瘤、结直肠癌与病理诊断的符合率分别为68，8％、76．9％、66．7％和80％，总病理符合率为73．4％；染色结肠镜分别为86．7％、87．5％、85．7％和90．9％，总病理符合率为87-5％：染色放大结肠镜分别为93．3％、91．7％、92．9％和90．9％，总病理符合率为92.2％。结论 普通结肠镜不能有效鉴别结直肠隆起性黏膜瘤性与非瘤性的改变，需要依赖病理组织学判断性质。染色结肠镜与染色放大结肠镜均能有效提高对结直肠隆起性黏膜瘤性与非瘤性病变的鉴别能力，具有较高的临床应用价值。染色结肠镜应列为常规检查以提高早期结肠肿瘤的检出率。     

染色结肠镜对大肠隆起性黏膜病变的应用价值

目的：探讨普通结肠镜、染色结肠镜在大肠隆起性黏膜病变中临床应用价值。方法：对90例结肠镜检查发现的黏膜隆起性病变,分别行普通结肠镜、染色结肠镜诊断。所有病变均作病理学检查。比较普通结肠镜、染色结肠镜诊断结果与病理学诊断结果。结果：共发现192个隆起性黏膜病变,普通结肠镜诊断为炎性息肉、管状腺瘤、绒毛状腺瘤、大肠癌与病理诊断的符合率分别为68.8%、76.9%、66.7%和80.0%,总病理符合率为73.4%;染色结肠镜分别为86.7%、87.5%、85.7%和90.9%,总病理符合率为87.5%。结论：染色结肠镜能有效提高大肠隆起性黏膜瘤性与非瘤性病变的鉴别能力,具有较高的临床应用价值。     

窄带成像与放大染色技术在诊断胃癌及癌前病变中的对比研究

目的应用窄带成像技术（NBI）和放大染色技术对胃可疑病变处进行观察,比较两种技术在诊断胃癌及癌前病变中的差异。方法选取2008年10月至12月进行放大胃镜检查患者中胃小凹分型为Ⅲ型以上的40例患者作为研究对象,对可疑病变处依次进行放大胃镜、NBI放大胃镜和放大染色胃镜观察,对三者图像的清晰度、胃小凹分型评价情况以及胃癌和癌前病变诊断情况进行比较。结果在这40例患者中,NBI放大胃镜下观察病变清晰度明显高于放大胃镜下和放大染色胃镜下（P〈0．05）;NBI放大胃镜与放大染色胃镜在胃小凹分型的评价方面,差异无统计学意义（P〉0．05）;NBI放大胃镜对胃癌及癌前病变诊断的准确性、敏感性、特异性与放大染色胃镜比较,差异无统计学意义（P〉0．05）。结论NBI通过对胃小凹形态改变的观察,从而发现可疑病变,精确引导活检,有助于提高胃癌及癌前病变的检出率。     

内镜窄带成像技术结合放大内镜在鉴别结直肠病变中的作用及其学习曲线

目的探讨内镜窄带成像技术(NBI)在诊断结直肠病变中的作用。明确NBI在实际操作中的学习曲线,为开展该技术的临床医师提供指导。方法回顾性分析2015年6月-2016年6月该院内镜中心4位医师行NBI结合放大内镜检查并发现结直肠病变的289例患者临床资料,所有病变经活检、内镜下治疗或手术后行病理组织学检查,并与佐野分型对照。根据NBI结合放大内镜分为3组,这3组包括可以通过内镜治疗(目标病变)的病变和不能通过内镜治疗(非目标病变)的病变。每位医师检查的目标或非目标病变均达到15例为1组。通过评估4名医师对每组病变的诊断准确性,绘制NBI结合放大内镜检查技术的相关学习曲线。结果在289例患者的结肠镜检查中共发现372处病变,NBI结合放大内镜使用佐野分型在鉴别肿瘤和非肿瘤性病变的准确率为95.1%、敏感性为98.0%、特异性为92.0%。对于目标及非目标病变的诊断准确率第2组相比第1组均有明显提高[分别为81.7%vs 95.1%(P=0.010)和71.7%vs 93.4%(P=0.000)];第2组与第3组病变之间的诊断准确率的差异无统计学意义(P=0.984及P=0.117)。结论 NBI结合放大内镜是诊断结直肠病变的有效工具。对于无NBI经验的医师在完成较短的训练计划和一定(对目标及非目标病变各15例)的临床实践后基本掌握其诊断方法,并获得有效、稳定的诊断准确率。     

Computed virtual chromoendoscopy: a new tool for enhancing tissue surface structures

We conducted a study of a newly developed "computed virtual chromoendoscopy" (CVC) system that enhances the contrast of the mucosal surface without the use of dyes. The CVC imaging technique is based on narrowing the bandwidth of the conventional endoscopic image arithmetically, using spectral estimation technology. Preliminary clinical tests comparing CVC-enhanced visualization of neoplastic and non-neoplastic lesions with images obtained by conventional endoscopy show that CVC enhances the vascular network as well as the pit pattern. CVC might therefore complement high-resolution endoscopy by facilitating the assessment of the nature and extent of gastrointestinal mucosal lesions.     

窄带内镜在胃肠道疾病诊断中的临床应用

对国外有关窄带内镜在胃肠疾病诊断中的文献进行复习,研究表明窄带内镜较普通内镜在胃肠肿瘤与非肿瘤性疾病鉴别中具有重要意义,与色素内镜效果相当。这一技术用于胃肠上皮肠化生、不典型增生及早癌诊断非常有前途,值得临床推广应用。     

窄带成像国际结直肠内镜分型在结直肠病变诊治中的价值*

目的评价非放大内镜下窄带成像(NBI)国际结直肠内镜分型(NICE)实时预判结直肠病变性质并指导治疗的价值。方法对结直肠隆起或扁平隆起性的黏膜病变采用NICE分型进行实时预判分类和处置建议,依据活检、内镜或外科手术后的病理结果评价NICE分型的敏感性、特异性、准确性、阳性预测值和阴性预测值。进行观察一致性检验。结果共计241例患者307处病变被纳入分析。其中非肿瘤性病变12.07%、腺瘤性病变82.07%、癌5.86%,病变直径0.1~6.0 cm。NICE分型预判肿瘤性及非肿瘤性病变的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为97.04%、89.19%、96.09%、98.50%和80.49%。一致性检验,判断肿瘤性病变和非肿瘤性病变的Kappa值为0.795,判断黏膜下深层病变和黏膜下浅层以上病变的Kappa值为0.875,总的Kappa值为0.814。结论 NICE分型能较准确地实时预判结直肠病变的性质并指导治疗,有利于推广仅将肿瘤性病变纳入内镜下切除或外科手术的适度治疗模式。     

窄带成像内镜对咽喉部位肿瘤患者活检中的应用价值

目的探讨窄带成像内镜(NBI)对咽喉部位肿瘤患者活检中的应用价值,为咽喉部位肿瘤的鉴别诊断提供参考。方法共纳入100例怀疑咽喉部位恶性肿瘤的患者作为研究对象,均在普通白光及NBI内镜条件下进行活检,并以最终病理结果为金标准,评价两种检查方法的应用价值。结果 100例怀疑咽喉部位恶性肿瘤患者中,最终病理确诊恶性56例,占56.0%,良性病变44例,占44.0%。普通白光活检正确率60.0%明显低于NBI内镜活检正确率75.0%,比较差异有统计学意义(P0.05)。NBI内镜敏感度为89.3%,特异度为63.6%均明显高于普通白光敏感度为75.0%,特异度为40.9%,比较差异有统计学意义(χ2=3.90,4.56,P=0.048,0.033)。结论 NBI内镜下咽喉部肿瘤为边界清晰的棕色斑点或条索状,活检中选取上述部位可提高恶性肿瘤的诊断敏感度、特异度及正确率。     

Indigo carmine-assisted high-magnification chromoscopic colonoscopy for the detection and characterisation of intraepithelial neoplasia in ulcerative colitis: a prospective evaluation

BACKGROUND AND STUDY AIMS: Recent data suggest that panchromoscopy using methylene blue can improve the detection of intraepithelial neoplastic lesions in the context of surveillance colonoscopy for patients with chronic ulcerative colitis. This method has also been shown to provide a more accurate diagnosis of the extent of disease and inflammatory activity. Interval cancers are known to occur in patients with chronic ulcerative colitis despite the adoption of currently accepted surveillance biopsy protocols. We hypothesised that targeted chromoscopy alone, with high-magnification imaging, may increase the total number of intraepithelial neoplastic lesions detected, compared with conventional colonoscopy and biopsy surveillance according to current protocols. PATIENTS AND METHODS: A total of 350 patients with long-standing ulcerative colitis (>or=8 years) underwent surveillance colonoscopy using high-magnification chromoscopic colonoscopy (HMCC). Quadrantic biopsies at 10-cm intervals were taken on extubation in addition to targeted biopsies of abnormal mucosal areas. Defined lesions were further evaluated using modified Kudo crypt pattern analysis. These data were compared with data from 350 disease duration- and disease extent-matched control patients who had undergone conventional colonoscopic surveillance between January 2001 and April 2005. RESULTS: Significantly more intraepithelial neoplastic lesions were detected in the magnification chromoscopy group compared with controls (69 vs. 24, P<0.0001). Intraepithelial neoplasia was observed in 67 lesions, of which 53 (79%) were detected using magnification chromoscopy alone. Chromoscopy increased the number of flat lesions with intraepithelial neoplasia detected compared with controls (P<0.001). Twenty intraepithelial neoplastic lesions were detected from 12,850 non-targeted biopsies in the HMCC group (0.16%), while 49 intraepithelial neoplastic lesions were detected from the 644 targeted biopsies in the HMCC group (8%). From 12,482 non-targeted biopsies taken in the control group patients, 18 (0.14%) showed intraepithelial neoplasia. The yield of intraepithelial neoplastic lesions from targeted biopsies in the control group (i. e. without HMCC imaging), however, was only modestly improved at 1.6% (6/369). Using modified Kudo criteria, the sensitivity and specificity for differentiating neoplastic from non-neoplastic lesions using HMCC were 93% and 88% respectively. The total procedure time was significantly longer in the HMCC group compared with controls (P<0.02). CONCLUSIONS: Magnification chromoscopy improves the detection of intraepithelial neoplasia in the endoscopic screening of patients with chronic ulcerative colitis. Neoplastic and non-neoplastic mucosal change can be predicted with a high overall accuracy using magnification techniques. These adjunctive endoscopic techniques have important clinical implications and may lead to changes in current practice guidelines.     

Characterization of colonic polyps at conventional (nonmagnifying) colonoscopy after spraying with 0.2 % indigo carmine dye

BACKGROUND AND STUDY AIMS: Japanese endoscopists have devised a classification system based on mucosal crypt patterns which is helpful for distinguishing between hyperplastic polyps, adenomas, and invasive cancers at colonoscopy. The aim of this study was to assess how well the various types of colonic polyp could be distinguished using conventional colonoscopes after spraying with 0.2 % indigo carmine dye. PATIENTS AND METHODS: The endoscopic appearances of all colonic lesions were assessed in 476 unselected patients using normal-resolution, nonmagnifying colonoscopes after spraying with 0.2 % indigo carmine dye. RESULTS: A total of 709 lesions were found in the 476 patients, and histology was available for 673 of these lesions: 187 lesions were found to be non-neoplastic (128 hyperplastic, 2 juvenile, 30 inflammatory, and 27 classified as "others"); 467 lesions were adenomatous; and 19 lesions were carcinomas. Of the 467 adenomas, 377 were tubular, 77 were tubulovillous, 8 were villous and 5 were serrated; 423/467 were correctly identified (sensitivity 91 %). Of the 187 non-neoplastic lesions, 153 were correctly classified (specificity 82 %). A total of 343 of the 377 tubular lesions were correctly identified as tubular adenomas (sensitivity 90 %), and 46 of the 77 tubulovillous lesions were correctly identified. CONCLUSIONS: Standard colonoscopy with dye spraying can be used to differentiate colonic polyps. Magnification is not always necessary to distinguish neoplastic from nonneoplastic colonic lesions. This finding could result in resource savings in colonoscopic screening.     

An evaluation of colorectal endoscopic mucosal resection using high-magnification chromoscopic colonoscopy: a prospective study of 1000 colonoscopies

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection provides an alternative to surgery for resection of sessile and flat colorectal lesions. High-magnification chromoscopic colonoscopy may allow early detection and anticipate histological diagnosis by identifying colonic crypt patterns. The aim of the present study was to assess the efficacy and safety of en-bloc endoscopic mucosal resection with high-magnification chromoendoscopy in the management of sessile and flat colorectal lesions 相似文献   

Magnification électronique en endoscopie digestive

Precise endoscopic assessment of gastrointestinal mucosal features is important to detect neoplastic lesions at an early stage. Electronic virtual chromoendoscopy markedly improves capillary pattern contrast and is an in vivo method for visualizing microvessel morphological changes in superficial neoplastic lesions. The scientific basis for this technique is that short wavelength light falls within the haemoglobin absorption band, thereby facilitating clearer visualization of vascular structures and pit pattern. Narrow band imaging (NBI, Olympus), multiband imaging (FICE) and i-scan are real-time, on-demand endoscopic imaging techniques available with high-definition endoscope. Potential indications include both the detection of premalignant lesions and differentiation between neoplastic and nonneoplastic lesions. The ease and readiness of use and the routine availability of virtual chromoendoscopy will probably contribute to its popularity. This does not alleviate the need to better define the role of these endoscopic techniques in daily practice by conducting well-designed prospective studies.     

Computer-aided colorectal tumor classification in NBI endoscopy using local features

An early detection of colorectal cancer through colorectal endoscopy is important and widely used in hospitals as a standard medical procedure. During colonoscopy, the lesions of colorectal tumors on the colon surface are visually inspected by a Narrow Band Imaging (NBI) zoom-videoendoscope. By using the visual appearance of colorectal tumors in endoscopic images, histological diagnosis is presumed based on classification schemes for NBI magnification findings. In this paper, we report on the performance of a recognition system for classifying NBI images of colorectal tumors into three types (A, B, and C3) based on the NBI magnification findings. To deal with the problem of computer-aided classification of NBI images, we explore a local feature-based recognition method, bag-of-visual-words (BoW), and provide extensive experiments on a variety of technical aspects. The proposed prototype system, used in the experiments, consists of a bag-of-visual-words representation of local features followed by Support Vector Machine (SVM) classifiers. A number of local features are extracted by using sampling schemes such as Difference-of-Gaussians and grid sampling. In addition, in this paper we propose a new combination of local features and sampling schemes. Extensive experiments with varying the parameters for each component are carried out, for the performance of the system is usually affected by those parameters, e.g. the sampling strategy for the local features, the representation of the local feature histograms, the kernel types of the SVM classifiers, the number of classes to be considered, etc. The recognition results are compared in terms of recognition rates, precision/recall, and F-measure for different numbers of visual words. The proposed system achieves a recognition rate of 96% for 10-fold cross validation on a real dataset of 908 NBI images collected during actual colonoscopy, and 93% for a separate test dataset.     

Colonoscopy and multidetector-array computed-tomographic colonography: detection rates and feasibility

BACKGROUND AND STUDY AIMS: Computed-tomographic (CT) colonography has been introduced as a minimally invasive colon examination for the detection of colorectal neoplasms. The aim of this study was to compare the performance characteristics of multidetector-array CT colonography (MDCTC) and conventional colonoscopy in a prospective, blinded design. PATIENTS AND METHODS: Sixty-six symptomatic patients, 75 patients undergoing polyp and cancer surveillance, and seven patients undergoing preoperative colonoscopy due to colorectal cancer (CRC) were examined with MDCTC and subsequent colonoscopy. The gold standard was colonoscopy. If MDCTC was positive and the first-pass colonoscopy was negative, a second-pass colonoscopy served as the gold standard. RESULTS: Complete colonoscopy was achieved in 91% of the patients, while technically satisfying MDCTC was obtained in 76% of the patients (P < 0.01), insufficient air distension in the sigmoid colon being the main problem. MDCTC and colonoscopy both detected all 11 carcinomas. Overall detection rates for polypoid lesions 6 mm or larger in size were 81% (95% CI, 70% to 90%) for MDCTC and 87% (95% CI, 77% to 94%) for colonoscopy (P = 0.52), with a significant difference with regard to the detection of polyps 6-9 mm in size in favor of colonoscopy (P = 0.008). The specificity of MDCTC at a 6-mm level was 97% (95% CI, 92% to 99%). CONCLUSIONS: MDCTC and colonoscopy show equal overall sensitivity for the detection of polypoid lesions 6 mm or larger in size, but more patients are inadequately examined when MDCTC is used.     

A useful approach to the differential diagnosis of small polypoid lesions of the gallbladder,utilizing an endoscopic ultrasound scoring system

BACKGROUND AND STUDY AIMS: The purpose of this study was to assess the accuracy of endoscopic ultrasonography (EUS) in making a differential diagnosis of small (< or = 20 mm in diameter) polypoid lesions of the gallbladder, and to construct an EUS scoring system. PATIENTS AND METHODS: The EUS findings were retrospectively analyzed in 70 surgical cases of small polypoid lesions classified into two groups: neoplastic (adenocarcinoma in 11, and adenoma in 7), and non-neoplastic (cholesterol polyp in 44, inflammatory polyp in 7 and fibrous polyp in 1). The EUS variables were the maximum diameter and height/width ratio of the largest polyps, echo level, internal echo pattern, surface patterns, number and shape of polyps, presence of hyperechoic spotting, complication of gallbladder stones. The EUS data were used for the construction of an EUS scoring system to ascertain the risk of neoplasia. RESULTS: Three EUS variables, i. e. tumor maximum size, internal echo pattern, and hyperechoic spotting were statistically significant according to multivariate analysis using stepwise logistic regression models (P < 0.01, P < 0.05, and P < 0.01, respectively). The total EUS score based on the coefficient of multivariate analysis was as follows: (maximum diameter in mm) + (internal echo pattern score; where heterogeneous = 4, homogeneous = 0) + (hyperechoic spot[s] score; where presence = - 5, absence = 0). According to our EUS scoring system, the sensitivity, specificity, and accuracy for the risk of neoplastic polyps with scores of 12 or higher were 77.8 %, 82.7 % and 82.9 %, respectively. CONCLUSIONS: The EUS scoring system will be a useful means of differentiating between neoplastic and non-neoplastic polyps of the gallbladder.