Internal Medicine, Engaru-Kosei General Hospital, Asahikawa, Japan.
Endoscopy. 2011 Oct;43(10):862-8. doi: 10.1055/s-0030-1256510. Epub 2011 Jul 5.
Conventional colonoscopy can result in unnecessary biopsy or endoscopic resection due to its inability to distinguish adenomas from hyperplastic polyps. This study therefore evaluated the efficacy of high-resolution endoscopy (HRE), autofluorescence imaging (AFI), and narrow-band imaging (NBI) in discriminating colon adenoma from hyperplastic polyps.
This was a prospective multicenter study in patients undergoing AFI and NBI examinations. HRE, AFI, and NBI images were classified into two groups based on morphological characteristics, the predominant color intensities, and the visibility of meshed capillary vessels, respectively. Each of the endoscopic photographs were independently evaluated by a single endoscopist. The images were then assessed by three specialists and three residents, the latter having performed < 500 colonoscopies and < 30 NBI and AFI examinations. Diagnostic test statistics were calculated to compare the accuracy in differentiating colon adenoma from hyperplastic polyps for each method.
A total of 183 patients were enrolled in the study and 339 adenomas and 85 hyperplastic polyps were identified. AFI and NBI could distinguish adenoma from hyperplastic polyps with an accuracy of 84.9 % and 88.4 %, respectively, whereas HRE exhibited an accuracy of 75.9 %. In the 358 lesions in which the AFI diagnosis was consistent with that of NBI, the accuracy, sensitivity, and specificity were high, at 91.9 %, 92.7 %, and 92.9 %, respectively. During the study comparing specialists and residents, AFI and NBI dramatically improved the diagnostic accuracy of residents from 69.1 % to 86.1 % and 84.7 %, respectively.
Both AFI and NBI are considered to be feasible tools that can discriminate colon adenoma from hyperplastic polyps, and their use may be particularly beneficial for less-experienced endoscopists.
传统的结肠镜检查由于无法区分腺瘤和增生性息肉，可能导致不必要的活检或内镜切除。因此，本研究评估了高分辨率内镜（HRE）、自体荧光成像（AFI）和窄带成像（NBI）在鉴别结肠腺瘤和增生性息肉方面的疗效。
这是一项前瞻性多中心研究，纳入了接受 AFI 和 NBI 检查的患者。根据形态特征、主导颜色强度和网格状毛细血管的可见性，将 HRE、AFI 和 NBI 图像分别分为两组。每位内镜医生独立评估每幅内镜图像。然后，由三位专家和三位住院医生评估这些图像，其中后者进行的结肠镜检查和 NBI、AFI 检查均少于 500 次和 30 次。计算诊断测试统计数据以比较每种方法区分结肠腺瘤和增生性息肉的准确性。
共有 183 名患者入组研究，共发现 339 个腺瘤和 85 个增生性息肉。AFI 和 NBI 鉴别腺瘤和增生性息肉的准确率分别为 84.9%和 88.4%，而 HRE 的准确率为 75.9%。在 AFI 诊断与 NBI 诊断一致的 358 个病变中，准确率、敏感度和特异度分别为 91.9%、92.7%和 92.9%。在比较专家和住院医生的研究中，AFI 和 NBI 显著提高了住院医生的诊断准确率，分别从 69.1%提高到 86.1%和 84.7%。
AFI 和 NBI 均被认为是能够鉴别结肠腺瘤和增生性息肉的可行工具，其应用可能对经验较少的内镜医生特别有益。
