Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
Endoscopy. 2011 Oct;43(10):869-75. doi: 10.1055/s-0030-1256663. Epub 2011 Aug 11.
Recent advances in endocytoscopy have enabled in vivo evaluation not on ly of structural atypia, but also of cellular atypia with observation of lumens and nuclei in the surface layer of the mucosa. The aim of this prospective pilot study was to evaluate the usefulness of our novel endocytoscopic classification in colorectal lesions.
A total of 206 consecutive patients were enrolled in the study and underwent endocytoscopic examination. Endocytoscopic images were stored electronically and two endoscopists blinded to the findings at live examination assigned them diagnoses using the endocytoscopic (EC) classification. The endocytoscopic diagnosis was then compared to the final histopathological diagnosis.
In all, 196 patients with 213 specimens were available for analysis. All normal mucosae were classified as EC1a and all hyperplastic polyps as EC1b. Dysplasias were mainly classified as EC2, while massively invasive submucosal cancers (SMm) or worse, which have the possibility of metastasis, were mainly EC3b. Assuming that an EC1b classification was diagnostic of hyperplastic polyps, we were able to differentiate nonneoplastic from neoplastic lesions with a sensitivity of 100 % and a specificity of 100 % (P < 0.05). Assuming that an EC3b classification was diagnostic of SMm or worse, we were able to differentiate "SMm or worse" from other neoplastic lesions (dysplasias and slightly invasive submucosal cancers) with a sensitivity of 90.1 % and a specificity of 99.2 % (P < 0.05).
The endocytoscopic classification was particularly useful for differentiating between neoplastic and nonneoplastic lesions and between "SMm or worse" and other neoplastic lesions, which in the case of colorectal neoplasms would help to determine treatment.
最近，内镜下细胞学检查的进步使得人们不仅能够对结构异型性进行评估，还能够对表层细胞的异型性进行评估，从而观察到腔道和细胞核。本前瞻性初步研究旨在评估我们新型内镜下细胞学分类在结直肠病变中的应用价值。
共纳入 206 例连续患者进行内镜下细胞学检查。将内镜下细胞学图像以电子方式储存，两位对实时检查结果不知情的内镜医生使用内镜下细胞学（EC）分类对其进行诊断。然后将内镜下细胞学诊断与最终的组织病理学诊断进行比较。
共有 196 例患者的 213 份标本可用于分析。所有正常黏膜均被归类为 EC1a，所有增生性息肉均被归类为 EC1b。异型增生主要被归类为 EC2，而具有转移可能性的大面积黏膜下浸润性癌症（SMm）或更差的病变则主要被归类为 EC3b。假设 EC1b 分类可诊断为增生性息肉，则我们能够以 100%的敏感性和 100%的特异性（P<0.05）区分非肿瘤性和肿瘤性病变。假设 EC3b 分类可诊断为 SMm 或更差，则我们能够以 90.1%的敏感性和 99.2%的特异性（P<0.05）区分“SMm 或更差”与其他肿瘤性病变（异型增生和轻度黏膜下浸润性癌症）。
内镜下细胞学分类对于区分肿瘤性和非肿瘤性病变以及“SMm 或更差”与其他肿瘤性病变特别有用，对于结直肠肿瘤，这有助于确定治疗方案。
