结肠胶囊内镜在侧向扩散性肿瘤检测中的临床疗效评估
Evaluation for the Clinical Efficacy of Colon Capsule Endoscopy in the Detection of Laterally Spreading Tumors.
作者信息
Igawa Atsushi, Oka Shiro, Tanaka Shinji, Otani Ichiro, Kunihara Sayoko, Chayama Kazuaki
机构信息
Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
出版信息
Digestion. 2017;95(1):43-48. doi: 10.1159/000452367. Epub 2017 Jan 5.
BACKGROUND AND AIM
The manner in which colorectal lesions are being detected with PillCam COLON2 capsule endoscopy (CCE2) has markedly improved in recent days. However, limited data are available on CCE2 for detecting laterally spreading tumors (LSTs). The aim of this study was to compare CCE2 with optical colonoscopy (OC), which is currently the gold standard used in the detection of LSTs.
METHODS
We performed a prospective, single-academic center study comparing CCE2 with OC in patients with LSTs diagnosed using OC, which was performed during the 3-month period prior to CCE2. We focused on the sensitivity and specificity of CCE2 for detecting LSTs. LSTs were classified into the LST-granular type (LST-G) or the LST-non-granular type (LST-NG).
RESULTS
Thirty patients (mean age 59.5 years) were enrolled. Of them, 21 LSTs (7 LST-Gs and 14 LST-NGs) were evaluated in this study. The mean diameter of the LSTs was 27 ± 15 mm (range 10-60 mm). Histopathological diagnoses of the LSTs were as follows: tubular adenoma, 12 cases (57%); sessile serrated adenoma/polyp (SSA/P), 4 cases (19%); Tis carcinoma, 1 case (5%); and T1 carcinoma, 4 cases (19 LSTs were found in the following locations: cecum, 1 case (5%); ascending colon, 6 cases (29%); transverse colon, 6 cases, (29%); descending colon, 1 case (5%); sigmoid colon, 3 cases (13%); and rectum, 4 cases (19%). The colon cleansing level was adequate in all cases. The sensitivity and specificity of CCE2 for detecting LSTs were 81 and 100% respectively. For detecting LST-Gs and LST-NGs, the sensitivity and specificity were 71 and 100%, and 86 and 100%, respectively. There were 4 false-negative cases (LST-G (18 mm), cecum; LST-G (20 mm), sigmoid colon; LST-NG (25 mm), transverse colon; LST-NG (20 mm), transverse colon).
CONCLUSIONS
The sensitivity for detecting LSTs is lower with CCE2 than it is with OC, especially for LSTs located on the right colon or for SSA/P.
背景与目的
近年来，使用结肠胶囊内镜2代（CCE2）检测结直肠病变的方式有了显著改善。然而，关于CCE2检测侧向发育型肿瘤（LSTs）的数据有限。本研究的目的是将CCE2与目前检测LSTs的金标准——光学结肠镜检查（OC）进行比较。
方法
我们进行了一项前瞻性、单学术中心研究，将CCE2与OC用于在CCE2前3个月内通过OC诊断为LSTs的患者。我们重点关注CCE2检测LSTs的敏感性和特异性。LSTs被分为颗粒型LST（LST-G）或非颗粒型LST（LST-NG）。
结果
共纳入30例患者（平均年龄59.5岁）。其中，本研究评估了21个LSTs（7个LST-Gs和14个LST-NGs）。LSTs的平均直径为27±15mm（范围10 - 60mm）。LSTs的组织病理学诊断如下：管状腺瘤12例（57%）；无蒂锯齿状腺瘤/息肉（SSA/P）4例（19%）；原位癌1例（5%）；T1期癌4例（19%）。LSTs位于以下部位：盲肠1例（5%）；升结肠6例（29%）；横结肠6例（29%）；降结肠1例（5%）；乙状结肠3例（13%）；直肠4例（19%）。所有病例的结肠清洁程度均足够。CCE2检测LSTs的敏感性和特异性分别为81%和100%。对于检测LST-Gs和LST-NGs，敏感性和特异性分别为71%和100%，以及86%和100%。有4例假阴性病例（盲肠LST-G（18mm）；乙状结肠LST-G（20mm）；横结肠LST-NG（25mm）；横结肠LST-NG（20mm））。
结论
CCE2检测LSTs的敏感性低于OC，尤其是对于位于右半结肠的LSTs或SSA/P。
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