Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Am J Gastroenterol. 2014 Jan;109(1):68-75. doi: 10.1038/ajg.2013.387. Epub 2013 Dec 3.
High-resolution microendoscopy (HRME) is a low-cost, "optical biopsy" technology that allows for subcellular imaging. The purpose of this study was to determine the in vivo diagnostic accuracy of the HRME for the differentiation of neoplastic from non-neoplastic colorectal polyps and compare it to that of high-definition white-light endoscopy (WLE) with histopathology as the gold standard.
Three endoscopists prospectively detected a total of 171 polyps from 94 patients that were then imaged by HRME and classified in real-time as neoplastic (adenomatous, cancer) or non-neoplastic (normal, hyperplastic, inflammatory).
HRME had a significantly higher accuracy (94%), specificity (95%), and positive predictive value (PPV, 87%) for the determination of neoplastic colorectal polyps compared with WLE (65%, 39%, and 55%, respectively). When looking at small colorectal polyps (less than 10 mm), HRME continued to significantly outperform WLE in terms of accuracy (95% vs. 64%), specificity (98% vs. 40%) and PPV (92% vs. 55%). These trends continued when evaluating diminutive polyps (less than 5 mm) as HRME's accuracy (95%), specificity (98%), and PPV (93%) were all significantly greater than their WLE counterparts (62%, 41%, and 53%, respectively).
In conclusion, this in vivo study demonstrates that HRME can be a very effective modality in the differentiation of neoplastic and non-neoplastic colorectal polyps. A combination of standard white-light colonoscopy for polyp detection and HRME for polyp classification has the potential to truly allow the endoscopist to selectively determine which lesions can be left in situ, which lesions can simply be discarded, and which lesions need formal histopathologic analysis.
高分辨率显微内镜（HRME）是一种低成本的“光学活检”技术，可实现亚细胞成像。本研究旨在确定 HRME 对区分肿瘤性和非肿瘤性结直肠息肉的体内诊断准确性，并将其与以组织病理学为金标准的高清白光内镜（WLE）进行比较。
三位内镜医生前瞻性地从 94 名患者中总共检测了 171 个息肉，然后通过 HRME 进行成像，并实时分类为肿瘤性（腺瘤性、癌性）或非肿瘤性（正常、增生性、炎症性）。
与 WLE 相比，HRME 对确定肿瘤性结直肠息肉的准确性（94%）、特异性（95%）和阳性预测值（PPV，87%）均显著更高。当观察小的结直肠息肉（小于 10mm）时，HRME 在准确性（95%对 64%）、特异性（98%对 40%）和 PPV（92%对 55%）方面仍显著优于 WLE。当评估微小息肉（小于 5mm）时，这些趋势仍在继续，因为 HRME 的准确性（95%）、特异性（98%）和 PPV（93%）均明显高于其 WLE 对应物（分别为 62%、41%和 53%）。
总之，这项体内研究表明，HRME 可非常有效地区分肿瘤性和非肿瘤性结直肠息肉。标准白光结肠镜检查用于息肉检测，HRME 用于息肉分类的组合，有可能真正使内镜医生能够有选择性地确定哪些病变可以原位保留，哪些病变可以简单丢弃，哪些病变需要进行正式的组织病理学分析。
