结肠镜检查、染色内镜检查和共聚焦内镜检查在溃疡性结肠炎和克罗恩病患者中的结直肠癌筛查。

Colorectal cancer screening in patients with ulcerative and Crohn's colitis with use of colonoscopy, chromoendoscopy and confocal endomicroscopy.

机构信息

Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Hospital Bratislava Ruzinov, Slovakia.

出版信息

Eur J Gastroenterol Hepatol. 2011 Aug;23(8):680-9. doi: 10.1097/MEG.0b013e32834791b4.

DOI:10.1097/MEG.0b013e32834791b4

PMID:21602687

Abstract

BACKGROUND

Patients with ulcerative colitis and Crohn's colitis have increased risk of colorectal cancer. Current screening endoscopy protocols based on white light endoscopy (WLE) and random biopsies are laborious and of uncertain sensitivity. Novel endoscopic techniques include chromoendoscopy (CE) and confocal laser endomicroscopy (CLE).

AIM

The aim was to compare WLE and CE for the detection of intraepithelial neoplasia (IEN). Furthermore, we analysed the sensitivity and specificity of CE and CLE for the diagnosis of IEN.

METHODS

The cohort consisted of 30 patients examined by WLE, CE with 0.4% indigocarmine, and by a CLE system Pentax EC-3870CIFK during one examination. Additional 15 patients were examined by conventional protocol only. Random biopsies and biopsies from all suspicious lesions were taken. We compared the number of IENs detected by WLE and CE and analysed the predictive values of CE and CLE for the histology diagnosis.

RESULTS

There were 1584 random biopsies (35.2 per patient) taken. There were 78 targeted biopsies (1.7 per patient) taken in 24 of 45 patients examined by WLE and an additional 36 biopsies in 16 of 30 patients examined by CE (1.17 additional per patient). There were no IENs found on random biopsies versus six low-grade or high-grade IENs in four patients (two detected by WLE, four additional by CE) from targeted biopsies, P=0.02. A total of 100 suspicious lesions were detected and analysed by CE and histology. CLE could not examine 32 of 100 lesions (two of 30 flat vs. 30 of 70 pedunculated lesions, P=0.0002, odds ratio 10.5). The sensitivity of CE/CLE for low-grade or high-grade IEN was 100/100%, the specificity 96.8/98.4%, positive predictive value was 62.5/66.7% and negative predictive value was 100/100%.

CONCLUSION

Targeted biopsies are superior to random biopsies in the screening of IEN in patients with inflammatory bowel disease. CE increases the diagnostic yield of WLE. In our study CLE did not provide additional clinical benefits.

摘要

背景

溃疡性结肠炎和克罗恩病患者结直肠癌的风险增加。目前基于白光内镜（WLE）和随机活检的筛查内镜检查方案既费力又不确定敏感性。新型内镜技术包括染色内镜（CE）和共聚焦激光内镜检查（CLE）。

目的

本研究旨在比较 WLE 和 CE 检测上皮内瘤变（IEN）的情况。此外，我们分析了 CE 和 CLE 诊断 IEN 的敏感性和特异性。

方法

该队列包括 30 例接受 WLE、CE（0.4%靛胭脂）和 Pentax EC-3870CIFK 型 CLE 系统检查的患者，以及另外 15 例仅接受常规方案检查的患者。对所有可疑病变进行随机活检和靶向活检。我们比较了 WLE 和 CE 检测到的 IEN 数量，并分析了 CE 和 CLE 对组织学诊断的预测价值。

结果

共进行了 1584 次随机活检（每位患者 35.2 次），在接受 WLE 检查的 45 例患者中的 24 例中进行了 78 次靶向活检（每位患者 1.7 次），在接受 CE 检查的 30 例患者中的 16 例中进行了另外 36 次活检（每位患者额外 1.17 次）。随机活检未发现 IEN，而在靶向活检中，来自 4 例患者的 6 例低级别或高级别 IEN（2 例由 WLE 检出，4 例由 CE 检出），P=0.02。总共对 100 个可疑病变进行了 CE 和组织学检查。CLE 无法检查 100 个病变中的 32 个（30 个平坦病变中有 2 个，70 个有蒂病变中有 30 个，P=0.0002，优势比 10.5）。CE/CLE 对低级别或高级别 IEN 的敏感性为 100/100%，特异性为 96.8/98.4%，阳性预测值为 62.5/66.7%，阴性预测值为 100/100%。