利用光学放大窄带成像技术研究无蒂锯齿状腺瘤/息肉的内镜特征。
Investigating endoscopic features of sessile serrated adenomas/polyps by using narrow-band imaging with optical magnification.
机构信息
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Department of Biostatistics, National Cancer Center, Tokyo, Japan.
出版信息
Gastrointest Endosc. 2015 Jul;82(1):108-17. doi: 10.1016/j.gie.2014.12.037. Epub 2015 Apr 1.
BACKGROUND
A sessile serrated adenoma/polyp (SSA/P) is a common type of colorectal polyp that possesses malignant potential. Although narrow-band imaging (NBI) can easily differentiate neoplastic lesions from hyperplastic polyps (HPs), SSA/Ps can be a challenge to distinguish from HPs.
OBJECTIVE
To investigate specific endoscopic features of SSA/Ps by using NBI with optical magnification.
DESIGN
Retrospective study.
SETTING
Single high-volume referral center.
PATIENTS
A total of 289 patients with histopathologically proven SSA/Ps or HPs obtained from colonoscopic polypectomy.
INTERVENTION
Endoscopic images obtained by using NBI with optical magnification of 242 lesions (124 HPs, 118 SSA/Ps) removed between January 2010 and December 2012 were independently evaluated by 2 experienced endoscopists. Three external experienced endoscopists systematically validated the diagnostic accuracies by using 40 lesions (21 HPs and 19 SSA/Ps) removed between January and March 2013.
MAIN OUTCOME MEASUREMENTS
Specific endoscopic features of SSA/Ps by using 5 potential characteristics: dilated and branching vessels (DBVs), irregular dark spots, a regular network pattern, a disorganized network pattern, and a dense pattern.
RESULTS
Multivariate analysis demonstrated that DBV had a 2.3-fold odds ratio (95% confidence interval, 0.96-5.69) among SSA/Ps compared with HPs (sensitivity, 56%; specificity, 75%; accuracy, 65%). Interobserver and intraobserver agreement indicated almost perfect agreement for DBVs in both the evaluation and validation studies. When DBVs, proximal location, and tumor size (≥10 mm) were combined, the positive predictive value was 92% and the area under the curve was 0.783 in the receiver-operating characteristics by using the validation group.
LIMITATIONS
Retrospective study.
CONCLUSIONS
The current study suggests that a DBV is a potentially unique endoscopic feature of a colorectal SSA/P.
背景
无蒂锯齿状腺瘤/息肉（SSA/P）是一种常见的结直肠息肉，具有恶性潜能。虽然窄带成像（NBI）可以轻松区分肿瘤性病变与增生性息肉（HP），但 SSA/P 可能难以与 HP 区分。
目的
通过使用具有光学放大的 NBI 研究 SSA/P 的特定内镜特征。
设计
回顾性研究。
设置
单一高容量转诊中心。
患者
共 289 例经组织病理学证实的 SSA/P 或 HP 患者，均来自结肠镜息肉切除术。
干预措施
2010 年 1 月至 2012 年 12 月间切除的 242 个病变（124 个 HP、118 个 SSA/P）的 NBI 图像，由 2 名经验丰富的内镜医师独立评估。3 名外部经验丰富的内镜医师使用 2013 年 1 月至 3 月间切除的 40 个病变（21 个 HP 和 19 个 SSA/P）系统地验证了诊断准确性。
主要观察指标
使用 5 种潜在特征（扩张和分支血管[DBV]、不规则暗点、规则网络模式、紊乱网络模式和密集模式）评估 SSA/P 的特定内镜特征。
结果
多变量分析表明，与 HP 相比，DBV 使 SSA/P 的比值比（95%置信区间，0.96-5.69）增加了 2.3 倍（敏感性，56%；特异性，75%；准确性，65%）。评估和验证研究中，DBV 的观察者间和观察者内一致性几乎为完全一致。当将 DBV、近端位置和肿瘤大小（≥10mm）结合起来时，验证组的阳性预测值为 92%，曲线下面积为 0.783。
局限性
回顾性研究。
结论
本研究表明，DBV 是结直肠 SSA/P 的一种潜在独特的内镜特征。
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