乙酸染色放大窄带成像诊断早期结直肠癌。
Magnifying narrow-band imaging with acetic acid to diagnose early colorectal cancer.
作者信息
Goto Norihiro, Kusaka Toshihiro, Tomita Yumi, Tanaka Hideyuki, Itokawa Yoshio, Koshikawa Yorimitsu, Yamaguchi Daisuke, Nakai Yoshitaka, Fujii Shigehiko, Kokuryu Hiroyuki
机构信息
Norihiro Goto, Toshihiro Kusaka, Yumi Tomita, Hideyuki Tanaka, Yoshio Itokawa, Yorimitsu Koshikawa, Daisuke Yamaguchi, Yoshitaka Nakai, Shigehiko Fujii, Hiroyuki Kokuryu, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto 615-8256, Japan.
出版信息
World J Gastroenterol. 2014 Nov 21;20(43):16306-10. doi: 10.3748/wjg.v20.i43.16306.
AIM
To evaluate the diagnostic characteristics of magnifying endoscopy with acetic acid spray and narrow-band imaging (MA-NBI) for early colorectal cancer.
METHODS
We conducted a prospective study to evaluate the diagnostic characteristics of MA-NBI in differentiating early colorectal adenocarcinomas from adenomas. To compare the results, we used magnifying endoscopy with NBI (M-NBI) and magnifying endoscopy with crystal violet staining (M-CV). The study was performed in 2 phases. In phase 1, 10 colonoscopists at our institution were shown still photographs of 35 colorectal polyps (24 adenocarcinomas and 11 adenomas) in M-NBI, MA-NBI, and M-CV. They made diagnostic predictions using a five-grade scoring evaluation. We plotted receiver operating characteristic curves and compared the areas under the curves (AUCs). In phase 2, colorectal polyps measuring ≥ 8 mm were prospectively enrolled. During real-time colonoscopy, one of the 7 colonoscopists scored the lesion as an adenocarcinoma or an adenoma and assigned a level of confidence to the prediction (high or low). We calculated the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each method and compared the proportions of high-confidence predictions.
RESULTS
In phase 1, the mean ± SD AUCs were 0.64 ± 0.031 in M-NBI, 0.71 ± 0.066 in MA-NBI, and 0.76 ± 0.059 in M-CV (P < 0.05 for M-NBI vs MA-NBI, P < 0.001 for M-NBI vs M-CV, and not significant for MA-NBI vs M-CV). In phase 2, 84 patients with 91 lesions (46 adenocarcinomas and 45 adenomas) were enrolled. The diagnostic characteristics were as follows: 73% accuracy, 85% sensitivity, 60% specificity, 68% PPV, and 79% NPV in M-NBI; 73% accuracy, 80% sensitivity, 64% specificity, 70% PPV, and 76% NPV in MA-NBI; and 73% accuracy, 83% sensitivity, 62% specificity, 69% PPV, and 78% NPV in M-CV. The proportions of high-confidence predictions were 57% in M-NBI, 75% in MA-NBI, and 76% in M-CV (P < 0.005 for M-NBI vs MA-NBI, P < 0.0005 for M-NBI vs M-CV, and P = 1.0 for MA-NBI vs M-CV).
CONCLUSION
MA-NBI is useful for differentiating early colorectal adenocarcinomas from adenomas.
目的
评估醋酸喷洒放大内镜联合窄带成像（MA-NBI）对早期结直肠癌的诊断特征。
方法
我们进行了一项前瞻性研究，以评估MA-NBI在鉴别早期结直肠腺癌与腺瘤方面的诊断特征。为比较结果，我们使用了窄带成像放大内镜（M-NBI）和结晶紫染色放大内镜（M-CV）。该研究分两个阶段进行。在第一阶段，向我们机构的10位结肠镜检查医师展示了35个结直肠息肉（24个腺癌和11个腺瘤）在M-NBI、MA-NBI和M-CV模式下的静态图像。他们使用五级评分评估进行诊断预测。我们绘制了受试者操作特征曲线并比较曲线下面积（AUC）。在第二阶段，前瞻性纳入直径≥8mm的结直肠息肉。在实时结肠镜检查期间，7位结肠镜检查医师中的一位将病变评为腺癌或腺瘤，并对预测给出置信水平（高或低）。我们计算了每种方法的准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），并比较了高置信度预测的比例。
结果
在第一阶段，M-NBI的平均±标准差AUC为0.64±0.031，MA-NBI为0.71±0.066，M-CV为0.76±0.059（M-NBI与MA-NBI比较，P<0.05；M-NBI与M-CV比较，P<0.001；MA-NBI与M-CV比较，差异无统计学意义）。在第二阶段，纳入了84例患者的91个病变（46个腺癌和45个腺瘤）。诊断特征如下：M-NBI的准确性为73%，敏感性为85%，特异性为60%，PPV为68%，NPV为79%；MA-NBI的准确性为73%，敏感性为80%，特异性为64%，PPV为70%，NPV为76%；M-CV的准确性为73%，敏感性为83%，特异性为62%，PPV为69%，NPV为78%。高置信度预测的比例在M-NBI中为57%，在MA-NBI中为75%，在M-CV中为76%（M-NBI与MA-NBI比较，P<0.005；M-NBI与M-CV比较，P<0.0005；MA-NBI与M-CV比较，P = 1.0）。
结论
MA-NBI有助于鉴别早期结直肠腺癌与腺瘤。
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