Takeuchi Yoji, Hanafusa Masao, Kanzaki Hiromitsu, Ohta Takashi, Hanaoka Noboru, Yamamoto Sachiko, Higashino Koji, Tomita Yasuhiko, Uedo Noriya, Ishihara Ryu, Iishi Hiroyasu
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, 537-8511, Japan.
J Gastroenterol. 2015 Oct;50(10):1017-26. doi: 10.1007/s00535-015-1048-1. Epub 2015 Feb 18.
The "resect and discard" strategy is beneficial for cost savings on screening and surveillance colonoscopy, but it has the risk to discard lesions with advanced histology or small invasive cancer (small advanced lesion; SALs). The aim of this study was to prove the principle of new "resect and discard" strategy with consideration for SALs using magnifying narrow-band imaging (M-NBI).
Patients undergoing colonoscopy at a tertiary center were involved in this prospective trial. For each detected polyp <10 mm, optical diagnosis (OD) and virtual management ("leave in situ", "discard" or "send for pathology") were independently made using non-magnifying NBI (N-NBI) and M-NBI, and next surveillance interval were predicted. Histological and optical diagnosis results of all polyps were compared.
While the management could be decided in 82% of polyps smaller than 10 mm, 24/31 (77%) SALs including two small invasive cancers were not discarded based on OD using M-NBI. The sensitivity [90% confidence interval (CI)] of M-NBI for SALs was 0.77 (0.61-0.89). The risk for discarding SALs using N-NBI was significantly higher than that using M-NBI (53 vs. 23%, p = 0.02). The diagnostic accuracy (95% CI) of M-NBI in distinguishing neoplastic from non-neoplastic lesions [0.88 (0.86-0.90)] was significantly better than that of N-NBI [0.84 (0.82-0.87)] (p = 0.005).
The results of our study indicated that our "resect and discard" strategy using M-NBI could work to reduce the risk for discarding SALs including small invasive cancer (UMIN-CTR, UMIN000003740).
“切除并丢弃”策略有利于节省筛查和监测结肠镜检查的费用，但存在丢弃组织学高级别或小的浸润性癌（小的高级别病变；SALs）病变的风险。本研究的目的是验证一种新的“切除并丢弃”策略的原理，该策略使用放大窄带成像（M-NBI）来考虑SALs。
在一家三级中心接受结肠镜检查的患者参与了这项前瞻性试验。对于每个检测到的直径<10 mm的息肉，使用非放大窄带成像（N-NBI）和M-NBI独立进行光学诊断（OD）和虚拟管理（“原位保留”、“丢弃”或“送病理检查”），并预测下一次监测间隔。比较所有息肉的组织学和光学诊断结果。
虽然82%的直径小于10 mm的息肉可以做出管理决策，但基于使用M-NBI的OD，24/31（77%）个SALs（包括两个小的浸润性癌）未被丢弃。M-NBI对SALs的敏感性[90%置信区间（CI）]为0.77（0.61-0.89）。使用N-NBI丢弃SALs的风险显著高于使用M-NBI（53%对23%，p = 0.02）。M-NBI区分肿瘤性与非肿瘤性病变的诊断准确性（95%CI）[0.88（0.86-0.90）]显著优于N-NBI[0.84（0.82-0.87）]（p = 0.005）。
我们的研究结果表明，我们使用M-NBI的“切除并丢弃”策略可以降低丢弃包括小浸润性癌在内的SALs的风险（UMIN-CTR，UMIN000003740）。
