East J E, Suzuki N, Bassett P, Stavrinidis M, Thomas H J, Guenther T, Tekkis P P, Saunders B P
Wolfson Unit for Endoscopy, St Mark's Hospital, Imperial College London, London, UK.
Endoscopy. 2008 Oct;40(10):811-7. doi: 10.1055/s-2008-1077586. Epub 2008 Sep 30.
Narrow band imaging (NBI) can accurately characterize colonic polyps using microvascular appearances. We aimed to assess whether the Kudo pit pattern classification is accurate when used with NBI (without dye-spray), and if microvascular appearances or NBI pit patterns maintain accuracy for polyp characterization at sizes < 10 mm.
116 polyps < 10 mm in size were detected in 62 patients undergoing surveillance colonoscopy. The polyps were prospectively assessed using NBI and magnification for Kudo pit pattern (III-V neoplastic, I-II non-neoplastic) and vascular pattern intensity (VPI), a measure of microvascular density (strong VPI, neoplastic; normal or weak VPI, non-neoplastic). Sensitivity, specificity, and accuracy were calculated and compared with results from histopathology.
The mean polyp size was 3.4 mm (range 1 - 9 mm). Overall, NBI pit pattern sensitivity, specificity, and accuracy were 0.88, 0.91, and 89.6 %, respectively. Equivalent values for VPI were 0.94, 0.89, and 91.4 %. Results were similar when polyps were subdivided into diminutive polyps (size <or= 5 mm) and flat polyps. Combining both pit pattern and VPI improved the sensitivity (0.98, P = 0.06 versus NBI pit pattern alone). There was very good agreement between NBI pit pattern and VPI for prediction of dysplasia (kappa = 0.83). No evidence of a learning curve for VPI was found. The NBI pit pattern was better than the VPI at subclassifying hyperplastic from other non-neoplastic polyps (sensitivity 0.79 versus 0.56, respectively, P = 0.02), but accuracy was poor.
The NBI pit pattern and VPI are both highly accurate in characterizing neoplastic colonic polyps of < 10 mm, with VPI appearing to be simple to learn. NBI has the potential to replace conventional histology for small polyps.
窄带成像（NBI）可利用微血管表现准确鉴别结肠息肉。我们旨在评估使用NBI（不进行染料喷洒）时，工藤凹坑模式分类是否准确，以及微血管表现或NBI凹坑模式对于直径<10mm的息肉鉴别是否仍保持准确性。
在62例行结肠镜监测的患者中检测到116个直径<10mm的息肉。前瞻性地使用NBI和放大内镜评估息肉的工藤凹坑模式（III-V型为肿瘤性，I-II型为非肿瘤性）和血管模式强度（VPI），VPI是微血管密度的一种测量指标（强VPI为肿瘤性；正常或弱VPI为非肿瘤性）。计算敏感性、特异性和准确性，并与组织病理学结果进行比较。
息肉平均大小为3.4mm（范围1-9mm）。总体而言，NBI凹坑模式的敏感性、特异性和准确性分别为0.88、0.91和89.6%。VPI的相应值为0.94、0.89和91.4%。将息肉分为微小息肉（直径≤5mm）和平坦息肉时，结果相似。联合凹坑模式和VPI可提高敏感性（0.98，与单独使用NBI凹坑模式相比，P=0.06）。NBI凹坑模式和VPI在预测发育异常方面一致性非常好（kappa=0.83）。未发现VPI存在学习曲线的证据。在将增生性息肉与其他非肿瘤性息肉进行亚分类时，NBI凹坑模式优于VPI（敏感性分别为0.79和0.56，P=0.02），但准确性较差。
NBI凹坑模式和VPI在鉴别直径<10mm的肿瘤性结肠息肉方面均高度准确，VPI似乎易于掌握。NBI有潜力取代小息肉的传统组织学检查。
