Chino Akiko, Osumi Hiroki, Kishihara Teruhito, Morishige Kenjiro, Ishikawa Hirotaka, Tamegai Yoshiro, Igarashi Masahiro
Division of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Dig Endosc. 2016 Apr;28 Suppl 1:53-9. doi: 10.1111/den.12631.
In the present study, we investigated the advantages of narrow-band imaging (NBI) for efficient diagnosis of sessile serrated adenoma/polyp (SSA/P). The main objective of this study was to analyze the characteristic features of cancer coexisting with serrated lesion by carrying out NBI.
We evaluated 264 non-malignant serrated lesions by using three modalities (conventional white light colonoscopy, magnifying chromoendoscopy, and magnifying NBI). Of the evaluated cancer cases with serrated lesions, 37 fulfilled the inclusion criteria.
In diagnosing non-malignant SSA/P, an expanded crypt opening (ECO) under magnifying NBI is a useful sign. One hundred and twenty-five lesions (87%) of observed ECO were, at the same time, detected to have type II open pit pattern, which is known to be a valuable indicator when using magnifying chromoendoscopy. ECO had high sensitivity of 80% for identifying SSA/P, with 62% specificity and 83% positive predictive value (PPV). In detecting the cancer with SSA/P, irregular vessels under magnifying NBI were frequently observed with 100% sensitivity and 99% specificity, 86% PPV and 100% negative predictive value.
A focus on irregular vessels in serrated lesions might be useful for identification of cancer with SSA/P. This is an advantage of carrying out magnifying NBI in addition to being used simultaneously with other modalities by switching, and observations can be made by using wash-in water alone. We can carry out advanced examinations for selected lesions with irregular vessels. To confirm cancerous demarcation and invasion depth, a combination of all three aforementioned modalities should be done.
在本研究中，我们探讨了窄带成像（NBI）在无蒂锯齿状腺瘤/息肉（SSA/P）高效诊断中的优势。本研究的主要目的是通过NBI分析与锯齿状病变共存的癌症的特征。
我们使用三种方式（传统白光结肠镜检查、放大染色内镜检查和放大NBI）评估了264例非恶性锯齿状病变。在评估的伴有锯齿状病变的癌症病例中，37例符合纳入标准。
在诊断非恶性SSA/P时，放大NBI下的隐窝开口扩大（ECO）是一个有用的征象。观察到的125个ECO病变（87%）同时被检测出具有II型开放型凹陷模式，这在使用放大染色内镜检查时是一个有价值的指标。ECO对识别SSA/P的敏感性高达80%，特异性为62%，阳性预测值（PPV）为83%。在检测伴有SSA/P的癌症时，放大NBI下的不规则血管经常被观察到，敏感性为100%，特异性为99%，PPV为86%，阴性预测值为100%。
关注锯齿状病变中的不规则血管可能有助于识别伴有SSA/P的癌症。这是进行放大NBI的一个优势，除了通过切换与其他方式同时使用外，仅通过水冲即可进行观察。我们可以对选定的伴有不规则血管的病变进行高级检查。为了确定癌边界和浸润深度，应结合上述所有三种方式进行检查。
