对小的结肠息肉进行光学诊断能准确吗？比较不带窄带成像的标准内镜与带窄带成像的高清内镜。
Can optical diagnosis of small colon polyps be accurate? Comparing standard scope without narrow banding to high definition scope with narrow banding.
作者信息
Ashktorab Hassan, Etaati Firoozeh, Rezaeean Farahnaz, Nouraie Mehdi, Paydar Mansour, Namin Hassan Hassanzadeh, Sanderson Andrew, Begum Rehana, Alkhalloufi Kawtar, Brim Hassan, Laiyemo Adeyinka O
机构信息
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
出版信息
World J Gastroenterol. 2016 Jul 28;22(28):6539-46. doi: 10.3748/wjg.v22.i28.6539.
AIM
To study the accuracy of using high definition (HD) scope with narrow band imaging (NBI) vs standard white light colonoscope without NBI (ST), to predict the histology of the colon polyps, particularly those < 1 cm.
METHODS
A total of 147 African Americans patients who were referred to Howard University Hospital for screening or, diagnostic or follow up colonoscopy, during a 12-mo period in 2012 were prospectively recruited. Some patients had multiple polyps and total number of polyps was 179. Their colonoscopies were performed by 3 experienced endoscopists who determined the size and stated whether the polyps being removed were hyperplastic or adenomatous polyps using standard colonoscopes or high definition colonoscopes with NBI. The histopathologic diagnosis was reported by pathologists as part of routine care.
RESULTS
Of participants in the study, 55 (37%) were male and median (interquartile range) of age was 56 (19-80). Demographic, clinical characteristics, past medical history of patients, and the data obtained by two instruments were not significantly different and two methods detected similar number of polyps. In ST scope 89% of polyps were < 1 cm vs 87% in HD scope (P = 0.7). The ST scope had a positive predictive value (PPV) and positive likelihood ratio (PLR) of 86% and 4.0 for adenoma compared to 74% and 2.6 for HD scope. There was a trend of higher sensitivity for HD scope (68%) compare to ST scope (53%) with almost the same specificity. The ST scope had a PPV and PLR of 38% and 1.8 for hyperplastic polyp (HPP) compared to 42% and 2.2 for HD scope. The sensitivity and specificity of two instruments for HPP diagnosis were similar.
CONCLUSION
Our results indicated that HD scope was more sensitive in diagnosis of adenoma than ST scope. Clinical diagnosis of HPP with either scope is less accurate compared to adenoma. Colonoscopy diagnosis is not yet fully matched with pathologic diagnosis of colon polyp. However with the advancement of both imaging and training, it may be possible to increase the sensitivity and specificity of the scopes and hence save money for eliminating time and the cost of Immunohistochemistry/pathology.
目的
研究使用带窄带成像（NBI）的高清（HD）结肠镜与不带NBI的标准白光结肠镜（ST）预测结肠息肉组织学的准确性，尤其是直径小于1cm的息肉。
方法
前瞻性招募了2012年12个月期间转诊至霍华德大学医院进行筛查、诊断或结肠镜随访的147名非裔美国患者。部分患者有多个息肉，息肉总数为179个。他们的结肠镜检查由3名经验丰富的内镜医师进行，这些医师使用标准结肠镜或带NBI的高清结肠镜确定息肉大小，并说明切除的息肉是增生性还是腺瘤性息肉。病理学家报告组织病理学诊断结果作为常规护理的一部分。
结果
研究参与者中，55名（37%）为男性，年龄中位数（四分位间距）为56岁（19 - 80岁）。患者的人口统计学、临床特征、既往病史以及两种仪器获得的数据无显著差异，两种方法检测到的息肉数量相似。在ST结肠镜中，89%的息肉直径小于1cm，HD结肠镜中这一比例为87%（P = 0.7）。ST结肠镜对腺瘤的阳性预测值（PPV）和阳性似然比（PLR）分别为86%和4.0，而HD结肠镜分别为74%和2.6。与ST结肠镜（53%）相比，HD结肠镜有更高的敏感性趋势（68%），特异性几乎相同。ST结肠镜对增生性息肉（HPP）的PPV和PLR分别为38%和1.8，而HD结肠镜分别为42%和2.2。两种仪器对HPP诊断的敏感性和特异性相似。
结论
我们的结果表明，HD结肠镜在腺瘤诊断中比ST结肠镜更敏感。与腺瘤相比，使用任何一种结肠镜对HPP进行临床诊断的准确性都较低。结肠镜诊断与结肠息肉的病理诊断尚未完全匹配。然而，随着成像技术和培训的进步，有可能提高结肠镜的敏感性和特异性，从而节省时间和免疫组织化学/病理学成本。
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