一项前瞻性多中心试验中使用放大窄带成像评估静止和动态图像在胃病变诊断中的应用
Assessment of still and moving images in the diagnosis of gastric lesions using magnifying narrow-band imaging in a prospective multicenter trial.
作者信息
Hayashi Tomoyuki, Doyama Hisashi, Shirota Yukihiro, Tsuji Hirokazu, Marukawa Youhei, Ohta Hajime, Miwa Kazuhiro, Masunaga Takaharu, Terasaki Shuichi, Matano Yutaka, Tsuji Kunihiro, Kaneko Yoshibumi, Okada Toshihide, Kurumaya Hiroshi, Kaneko Shuichi
机构信息
Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan.
Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa, Japan.
出版信息
PLoS One. 2014 Jul 2;9(7):e100857. doi: 10.1371/journal.pone.0100857. eCollection 2014.
OBJECTIVES
Magnifying narrow-band imaging (M-NBI) is more accurate than white-light imaging for diagnosing small gastric cancers. However, it is uncertain whether moving M-NBI images have additional effects in the diagnosis of gastric cancers compared with still images.
DESIGN
A prospective multicenter cohort study.
METHODS
To identify the additional benefits of moving M-NBI images by comparing the diagnostic accuracy of still images only with that of both still and moving images. Still and moving M-NBI images of 40 gastric lesions were obtained by an expert endoscopist prior to this prospective multicenter cohort study. Thirty-four endoscopists from ten different Japanese institutions participated in the prospective multicenter cohort study. Each study participant was first tested using only still M-NBI images (still image test), then tested 1 month later using both still and moving M-NBI images (moving image test). The main outcome was a difference in the diagnostic accuracy of cancerous versus noncancerous lesions between the still image test and the moving image test.
RESULTS
Thirty-four endoscopists were analysed. There were no significant difference of cancerous versus noncancerous lesions between still and moving image tests in the diagnostic accuracy (59.9% versus 61.5%), sensitivity (53.4% versus 55.9%), and specificity (67.0% versus 67.6%). And there were no significant difference in the diagnostic accuracy between still and moving image tests of demarcation line (65.4% versus 65.5%), microvascular pattern (56.7% versus 56.9%), and microsurface pattern (48.1% versus 50.9%). Diagnostic accuracy showed no significant difference between the still and moving image tests in the subgroups of endoscopic findings of the lesions.
CONCLUSIONS
The addition of moving M-NBI images to still M-NBI images does not improve the diagnostic accuracy for gastric lesions. It is reasonable to concentrate on taking sharp still M-NBI images during endoscopic observation and use them for diagnosis.
TRIAL REGISTRATION
Umin.ac.jp UMIN-CTR000008048.
目的
放大窄带成像（M-NBI）在诊断小胃癌方面比白光成像更准确。然而，与静态图像相比，动态M-NBI图像在胃癌诊断中是否具有额外作用尚不确定。
设计
一项前瞻性多中心队列研究。
方法
通过比较仅静态图像与静态和动态图像两者的诊断准确性，来确定动态M-NBI图像的额外益处。在这项前瞻性多中心队列研究之前，由一名内镜专家获取40个胃部病变的静态和动态M-NBI图像。来自日本十个不同机构的34名内镜医师参与了这项前瞻性多中心队列研究。每位研究参与者首先仅使用静态M-NBI图像进行测试（静态图像测试），然后在1个月后使用静态和动态M-NBI图像进行测试（动态图像测试）。主要结果是静态图像测试和动态图像测试之间癌性与非癌性病变诊断准确性的差异。
结果
对34名内镜医师进行了分析。在诊断准确性（59.9%对61.5%）、敏感性（53.4%对55.9%）和特异性（67.0%对67.6%）方面，静态和动态图像测试之间癌性与非癌性病变无显著差异。在分界线的静态和动态图像测试之间（65.4%对65.5%）、微血管形态（56.7%对56.9%）和微表面形态（48.1%对50.9%）的诊断准确性也无显著差异。在病变内镜检查结果的亚组中，静态和动态图像测试之间的诊断准确性无显著差异。
结论
在静态M-NBI图像基础上增加动态M-NBI图像并不能提高胃部病变的诊断准确性。在内镜观察期间专注于拍摄清晰的静态M-NBI图像并将其用于诊断是合理的。
试验注册
umin.ac.jp UMIN-CTR000008048。
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