Shibagaki Kotaro, Amano Yuji, Ishimura Norihisa, Yuki Takafumi, Taniguchi Hideaki, Fujita Hiraku, Kobayashi Keita, Kinoshita Yoshikazu
Departments of *Gastroenterology ∥Pathology, Tottori Municipal Hospital, Tottori †Division of Endoscopy, Kaken Hospital, International University of Health and Welfare, Ichikawa ‡Department of Gastroenterology, Faculty of Medicine, Shimane University §Division of Endoscopy, Shimane University Hospital, Izumo, Japan.
J Clin Gastroenterol. 2015 Apr;49(4):306-12. doi: 10.1097/MCG.0000000000000148.
Pit pattern (PP) analysis of colorectal neoplasms using magnification chromoendoscopy with crystal violet (CV-MCE) is useful for predicting histologic features, but it is time consuming. Capillary pattern analysis by magnification endoscopy with narrow-band imaging (NBIME) is a useful and simpler procedure, but its diagnostic accuracy may be inferior to CV-MCE. NBIME with acetic acid enhancement (A-NBIME) is effective for rapid visualization of gastric mucosal microstructures. We performed a prospective study to compare the diagnostic reliability and feasibility of A-NBIME and CV-MCE in PP diagnosis of colorectal neoplasms.
The present study consisted of 3 protocols: Study-1 assessed 56 colorectal lesions photographed with A-NBIME and CV-MCE, and the endoscopic images were reviewed by 3 experts to compare the diagnostic concordance; study-2 assessed 202 colorectal lesions photographed with A-NBIME in 116 consecutive patients and the correlation between PP and histologic findings; study-3 randomly allocated 100 patients with colorectal lesions equally to A-NBIME and CV-MCE, and compared the procedure time and visible ratio of PP.
The κ value for interobserver agreement for A-NBIME and CV-MCE was 0.71 (0.66 to 0.75) and 0.80 (0.75 to 0.85), respectively. Intraobserver agreement between modalities for each reviewer was 0.79 (0.70 to 0.88), 0.80 (0.71 to 0.90), and 0.74 (0.67 to 0.82). Non-neoplastic polyps and massively invasive submucosal adenocarcinomas were statistically related to type II and type VI-H/VN. The procedure time was statistically shorter with A-NBIME than with CV-MCE (31 vs. 81 s), and the visible ratio of PP was equivalent (98.9% vs. 98.3%).
A-NBIME is comparable with CV-MCE in PP diagnosis of colorectal neoplasms and is a simpler technique.
使用结晶紫放大染色内镜检查（CV-MCE）对结直肠肿瘤进行凹窝形态（PP）分析有助于预测组织学特征，但耗时较长。窄带成像放大内镜检查（NBIME）进行的毛细血管形态分析是一种有用且更简单的方法，但其诊断准确性可能低于CV-MCE。醋酸增强窄带成像放大内镜检查（A-NBIME）可有效快速显示胃黏膜微观结构。我们进行了一项前瞻性研究，比较A-NBIME和CV-MCE在结直肠肿瘤PP诊断中的诊断可靠性和可行性。
本研究包括3个方案：方案1评估了56个用A-NBIME和CV-MCE拍摄的结直肠病变，3位专家对内镜图像进行评估以比较诊断一致性；方案2评估了116例连续患者中用A-NBIME拍摄的202个结直肠病变以及PP与组织学结果之间的相关性；方案3将100例结直肠病变患者随机平均分配至A-NBIME组和CV-MCE组，比较操作时间和PP的可见率。
A-NBIME和CV-MCE的观察者间一致性κ值分别为0.71（0.66至0.75）和0.80（0.75至0.85）。每位评估者两种检查方式间的观察者内一致性分别为0.79（0.70至0.88）、0.80（0.71至0.90）和0.74（0.67至0.82）。非肿瘤性息肉和大量浸润性黏膜下腺癌在统计学上与II型和VI-H/VN型相关。A-NBIME的操作时间在统计学上短于CV-MCE（31秒对81秒），PP的可见率相当（98.9%对98.3%）。
在结直肠肿瘤的PP诊断中，A-NBIME与CV-MCE相当，且是一种更简单的技术。
