在有经验和无经验的内镜医师中，联合使用自体荧光成像和窄带成像以鉴别腺瘤与非肿瘤性结肠息肉。
Combining autofluorescence imaging and narrow-band imaging for the differentiation of adenomas from non-neoplastic colonic polyps among experienced and non-experienced endoscopists.
作者信息
van den Broek Frank J C, van Soest Ellert J, Naber Anton H, van Oijen Arnoud H A M, Mallant-Hent Rosalie Ch, Böhmer Clarisse J M, Scholten Pieter, Stokkers Pieter C F, Marsman Willem A, Mathus-Vliegen Elisabeth M H, Curvers Wouter L, Bergman Jacques J G H M, van Eeden Susanne, Hardwick James C H, Fockens Paul, Reitsma Johannes B, Dekker Evelien
机构信息
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
出版信息
Am J Gastroenterol. 2009 Jun;104(6):1498-507. doi: 10.1038/ajg.2009.161. Epub 2009 Apr 28.
OBJECTIVES
Endoscopic tri-modal imaging incorporates high-resolution white-light endoscopy (HR-WLE), narrow-band imaging (NBI), and autofluorescence imaging (AFI). Combining these advanced techniques may improve endoscopic differentiation between adenomas and non-neoplastic polyps. In this study, we aimed to assess the interobserver variability and accuracy of HR-WLE, NBI, and AFI for polyp differentiation and to evaluate the combined use of AFI and NBI.
METHODS
First, still images of 50 polyps (22 adenomas; median 3 mm) were randomly displayed to three experienced and four non-experienced endoscopists. All HR-WLE and NBI images were scored for Kudo classification and AFI images for color. Second, the combined AFI and NBI images were assessed using a newly developed algorithm by six additional non-experienced endoscopists.
RESULTS
The outcomes measured were interobserver agreement and diagnostic accuracy using histopathology as reference standard. Experienced endoscopists had better interobserver agreement for NBI (kappa=0.77) than for AFI (kappa=0.33), whereas non-experienced endoscopists had better agreement for AFI (kappa=0.58) than for NBI (kappa=0.33). The accuracies of HR-WLE, NBI, and AFI among experienced endoscopists were 65, 70, and 74, respectively. Figures among non-experienced endoscopists were 57, 63, and 77. The algorithm was associated with a significantly higher accuracy of 85% among all observers (P<0.023). These figures were confirmed in the second evaluation study.
CONCLUSIONS
Non-experienced endoscopists have better interobserver agreement and accuracy for AFI than for HR-WLE or NBI, indicating that AFI is easier to use for polyp differentiation in non-experienced setting. The newly developed algorithm, combining information of AFI and NBI together, had the highest accuracy and obtained equal results between experienced and non-experienced endoscopists.
目的
内镜三模态成像结合了高分辨率白光内镜检查（HR-WLE）、窄带成像（NBI）和自体荧光成像（AFI）。联合使用这些先进技术可能会改善腺瘤与非肿瘤性息肉之间的内镜鉴别。在本研究中，我们旨在评估HR-WLE、NBI和AFI在息肉鉴别方面的观察者间变异性和准确性，并评估AFI与NBI的联合应用。
方法
首先，将50个息肉（22个腺瘤；中位数为3毫米）的静态图像随机展示给3名经验丰富的内镜医师和4名经验不足的内镜医师。所有HR-WLE和NBI图像按照工藤分类法进行评分，AFI图像按照颜色进行评分。其次，另外6名经验不足的内镜医师使用一种新开发的算法对联合的AFI和NBI图像进行评估。
结果
以组织病理学作为参考标准测量的结果是观察者间一致性和诊断准确性。经验丰富的内镜医师对NBI的观察者间一致性（kappa=0.77）优于AFI（kappa=0.33），而经验不足的内镜医师对AFI的一致性（kappa=0.58）优于NBI（kappa=0.33）。经验丰富的内镜医师中，HR-WLE、NBI和AFI的准确率分别为65%、70%和74%。经验不足的内镜医师中的相应数字分别为57%、63%和77%。该算法在所有观察者中的准确率显著更高，为85%（P<0.023）。这些数字在第二项评估研究中得到了证实。
结论
经验不足的内镜医师在AFI的观察者间一致性和准确性方面优于HR-WLE或NBI，这表明在经验不足的情况下，AFI更易于用于息肉鉴别。新开发的算法将AFI和NBI的信息结合在一起，具有最高的准确性，并且在经验丰富和经验不足的内镜医师之间获得了相同的结果。
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