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。

Significance of endoscopic mucosal surface features in diagnosing colorectal polyps

Objective To investigate whether the morphological features of mucosal surface observed by high definition colonoscopy without optical magnification could help predicting the histological type of colorectal polyps. Methods A total of 142 cases with 330 polyploidy lesions were inspected by high-definition colonoscopy. The mucosal pit type （pit pattern, PP） was evaluated by close observation and the mucosal vascular morphology （capillary pattern, CP） was observed by narrow-band imaging （NBI）. The predicted histological diagnosis was compared with the pathological diagnosis to determine its sensitivity, specificity and accuracy. Results The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, negative likelihood ratio and positive likelihood ratio of PP combining CP in predicting the histological type of colorectal polyps were 88.2%, 83.6%, 95.5%, 64. 4%, 87.3%, 5.4 and 0. 1. Conclusions The morphological features of mucosal surface observed by close observation combined with NBI by high-definition colonoscopy could help predicting the histological type of colorectal polyps and determining further treatment and follow-up program.