Tung S Y, Wu C S, Su M Y
Department of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Am J Gastroenterol. 2001 Sep;96(9):2628-32. doi: 10.1111/j.1572-0241.2001.04120.x.
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.
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.
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.
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.
由于结肠腺瘤性息肉患者的医学管理与增生性息肉患者不同，诊断准确性至关重要。本研究报告了我们使用放大结肠镜结合靛胭脂染料诊断结肠息肉的经验，重点强调其区分肿瘤性病变与非肿瘤性病变的能力。
材料包括175个息肉。在普通结肠镜检查发现病变后，喷洒0.2%的靛胭脂溶液，然后使用结肠镜变焦装置进行放大观察。根据工藤改良分类法，将凹窝形态分为六类：I型、II型、III（L）型、III s型、IV型和V型。
凹窝形态为I型、II型、III（L）型、III s型、IV型和V型的病变中，肿瘤性改变的百分比分别为0%、12.2%、69.7%、80%、84.4%和100%。当I型和II型代表非肿瘤性病变的凹窝形态，III（L）型、III s型、IV型和V型代表肿瘤性病变时，肿瘤性病变的诊断敏感性为93.8%，特异性为64.6%。区分肿瘤性病变与非肿瘤性病变的总体诊断准确性为80.1%。诊断准确性不受病变大小和形状的影响。6个被误判为非肿瘤性的肿瘤性病变在组织学上为仅具有轻度异型性的腺瘤。
通过放大结肠镜对结肠病变进行凹窝形态分析是区分大肠肿瘤性病变与非肿瘤性病变的一种有用且客观的工具。然而，就其目前的发展状态而言，该技术不能替代组织学检查。
