Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
Dig Dis Sci. 2014 Jul;59(7):1520-8. doi: 10.1007/s10620-014-3090-x. Epub 2014 May 20.
Distinguishing deep submucosa (SM) from superficial SM cancer in large sessile and flat colorectal polyps (>2 cm) is crucial in making the most appropriate therapeutic decision. We evaluated the additional role of magnifying narrow-band imaging (NBI) and magnifying chromoendoscopy (MCE) in assessing the depth of invasion in large sessile and flat polyps in comparison to morphological evaluation performed by experienced endoscopists.
From May 2011 to December 2011, a total of 85 large sessile and flat polyps were analyzed. Endoscopic features of the polyps were independently evaluated by experienced endoscopists. Subsequently, the polyps were observed using magnifying NBI and MCE.
A total of 58 intramucosal lesions and 27 SM cancers (five superficial and 22 deep) were identified. The diagnostic accuracy of the experienced endoscopists, NBI, and MCE were 92.9, 90.6, and 89.4 %, respectively, for deep SM cancer. In combination with NBI or MCE, the diagnostic accuracy of the experienced endoscopists did not change significantly for deep SM cancer, with an accuracy of 95.3 % for both NBI and MCE.
Conventional colonoscopy can differentiate superficial from deep SM cancers with an accuracy of as high as 92.9 % in large sessile and flat polyps. Further diagnostic strategies are required in order to precisely assess the depth of invasion, especially in large colorectal polyps.
在大型无蒂和扁平结直肠息肉（>2cm）中，区分黏膜固有层（SM）深部和浅层 SM 癌症对于做出最合适的治疗决策至关重要。我们评估了放大窄带成像（NBI）和放大 chromoendoscopy（MCE）在评估大型无蒂和扁平息肉浸润深度方面相对于经验丰富的内镜医师进行形态学评估的额外作用。
2011 年 5 月至 2011 年 12 月，共分析了 85 个大型无蒂和扁平息肉。息肉的内镜特征由经验丰富的内镜医师独立评估。随后，使用放大 NBI 和 MCE 观察息肉。
共发现 58 个黏膜内病变和 27 个 SM 癌（浅层 5 个，深层 22 个）。经验丰富的内镜医师、NBI 和 MCE 对深层 SM 癌的诊断准确率分别为 92.9%、90.6%和 89.4%。结合 NBI 或 MCE，经验丰富的内镜医师对深层 SM 癌的诊断准确率并未显著改变，NBI 和 MCE 的准确率均为 95.3%。
在大型无蒂和扁平息肉中，常规结肠镜检查可以将浅层和深层 SM 癌区分开来，准确率高达 92.9%。为了更准确地评估浸润深度，特别是在大型结直肠息肉中，需要进一步的诊断策略。
