内镜预测黏膜下深层浸润癌：窄带成像国际结直肠内镜（NICE）分类的验证。

Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification.

机构信息

Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.

出版信息

Gastrointest Endosc. 2013 Oct;78(4):625-32. doi: 10.1016/j.gie.2013.04.185. Epub 2013 Jul 30.

DOI:10.1016/j.gie.2013.04.185

PMID:23910062

Abstract

BACKGROUND

A simple endoscopic classification to accurately predict deep submucosal invasive (SM-d) carcinoma would be clinically useful.

OBJECTIVE

To develop and assess the validity of the NBI international colorectal endoscopic (NICE) classification for the characterization of SM-d carcinoma.

DESIGN

The study was conducted in 4 phases: (1) evaluation of endoscopic differentiation by NBI-experienced colonoscopists; (2) extension of the NICE classification to incorporate SM-d (type 3) by using a modified Delphi method; (3) prospective validation of the individual criteria by inexperienced participants, by using high-definition still images without magnification of known histology; and (4) prospective validation of the individual criteria and overall classification by inexperienced participants after training.

SETTING

Japanese academic unit.

MAIN OUTCOME MEASUREMENTS

Performance characteristics of the NICE criteria (phase 3) and overall classification (phase 4) for SM-d carcinoma; sensitivity, specificity, predictive values, and accuracy.

RESULTS

We expanded the NICE classification for the endoscopic diagnosis of SM-d carcinoma (type 3) and established the predictive validity of its individual components. The negative predictive values of the individual criteria for diagnosis of SM-d carcinoma were 76.2% (color), 88.5% (vessels), and 79.1% (surface pattern). When any 1 of the 3 SM-d criteria was present, the sensitivity was 94.9%, and the negative predictive value was 95.9%. The overall sensitivity and negative predictive value of a global, high-confidence prediction of SM-d carcinoma was 92%. Interobserver agreement for an overall SM-d carcinoma prediction was substantial (kappa 0.70).

LIMITATIONS

Single Japanese center, use of still images without prospective clinical evaluation.

CONCLUSION

The NICE classification is a valid tool for predicting SM-d carcinomas in colorectal tumors.

摘要

背景

一种简单的内镜分类方法，如果能够准确预测深度黏膜下浸润（SM-d）癌，将具有重要的临床应用价值。

目的

建立并评估窄带成像国际结直肠内镜（NBI）分类对 SM-d 癌特征的诊断效能。

设计

该研究分 4 个阶段进行：（1）经验丰富的结肠镜医师评估 NBI 下的内镜分化程度；（2）采用改良 Delphi 法将 NICE 分类扩展至包括 SM-d（3 型）；（3）使用未经培训的参与者，通过高清静态图像（不放大）评估已知组织学的 NICE 分类各标准的前瞻性验证；（4）在培训后，由未经培训的参与者对 NICE 分类各标准和整体分类进行前瞻性验证。

地点

日本某学术单位。

主要观察指标

SM-d 癌的 NICE 标准（第 3 阶段）和整体分类（第 4 阶段）的性能特征；敏感性、特异性、预测值和准确性。

结果

我们扩展了 NICE 分类以用于 SM-d 癌的内镜诊断（3 型），并建立了其各组成部分的预测有效性。单一 NICE 标准对 SM-d 癌诊断的阴性预测值分别为：色泽（76.2%）、血管（88.5%）和表面模式（79.1%）。当存在 3 种 SM-d 标准中的任何 1 种时，敏感性为 94.9%，阴性预测值为 95.9%。整体上，对 SM-d 癌的高可信度预测的敏感性和阴性预测值均为 92%。对整体 SM-d 癌预测的观察者间一致性为中等（kappa 值 0.70）。