Department of Endoscopy, Jikei University School of Medicine, Minato-ku, Tokyo 105-8461, Japan.
Eur J Gastroenterol Hepatol. 2013 Apr;25(4):488-94. doi: 10.1097/MEG.0b013e32835c6d9a.
Differentiating non-neoplastic colorectal lesions from neoplastic lesions during screening colonoscopies is essential to reduce the unnecessary treatment of non-neoplastic lesions. The present study was conducted to verify the diagnostic yields of the computer-aided diagnostic system that enables 'real-time' color analysis of colorectal lesions when applied to autofluorescence endoscopy (AFE).
Consecutive patients who were scheduled to undergo a therapeutic colonoscopy in our department were enrolled in this study. The encountered lesions were evaluated in AFE and color-tone sampling was performed. Lesions with green/red (G/R) ratios less than 1.01 were judged to be neoplastic and those with G/R ratios of at least 1.01 were considered to be non-neoplastic. All lesions greater than 5 mm were endoscopically removed and lesions less than 5 mm were biopsied.
During the study period, a total of 32 patients with 102 colorectal lesions were evaluated with AFE. The mean G/R ratio for all neoplastic lesions was 0.86 [95% confidence interval (CI), 0.63-1.01], which was significantly lower than the mean G/R ratio for non-neoplastic lesions (1.12; 95% CI, 0.98-1.26; P<0.001). The mean G/R ratios were 1.36 (95% CI, 1.21-1.57) in normal mucosa, 1.12 (95% CI, 0.98-1.26) in hyperplastic lesions, 0.88 (95% CI, 0.69-1.02) in adenomas, and 0.61 (95% CI, 0.54-0.73) in intramucosal cancers. A G/R ratio cutoff value of 1.01 was applied for discriminating between neoplastic lesions and non-neoplastic lesions, and yielded sensitivity, specificity, positive and negative predictive values of 94.2, 88.9, 95.6, and 85.2%, respectively.
This diagnostic tool may lead to the reduction of unnecessary treatments for non-neoplastic lesions.
在筛查结肠镜检查中，区分非肿瘤性结直肠病变与肿瘤性病变对于减少非肿瘤性病变的不必要治疗至关重要。本研究旨在验证计算机辅助诊断系统在应用于自发荧光内镜（AFE）时对“实时”结直肠病变颜色分析的诊断效果。
本研究纳入了在我科接受治疗性结肠镜检查的连续患者。对遇到的病变进行 AFE 评估，并进行颜色色调采样。绿色/红色（G/R）比值小于 1.01 的病变判断为肿瘤性，G/R 比值大于等于 1.01 的病变则认为是非肿瘤性。所有大于 5mm 的病变均进行内镜切除，小于 5mm 的病变则进行活检。
在研究期间，共对 32 例患者的 102 个结直肠病变进行了 AFE 评估。所有肿瘤性病变的平均 G/R 比值为 0.86[95%置信区间（CI），0.63-1.01]，显著低于非肿瘤性病变的平均 G/R 比值（1.12；95%CI，0.98-1.26；P<0.001）。正常黏膜的平均 G/R 比值为 1.36（95%CI，1.21-1.57），增生性病变为 1.12（95%CI，0.98-1.26），腺瘤为 0.88（95%CI，0.69-1.02），黏膜内癌为 0.61（95%CI，0.54-0.73）。将 G/R 比值截断值设定为 1.01 用于区分肿瘤性病变与非肿瘤性病变，其灵敏度、特异性、阳性预测值和阴性预测值分别为 94.2%、88.9%、95.6%和 85.2%。
该诊断工具可能会减少非肿瘤性病变的不必要治疗。
