新内镜虚拟染色内镜评分的开发和可靠性：溃疡性结肠炎的 PICaSSO（帕丁顿国际虚拟染色内镜评分）。
Development and reliability of the new endoscopic virtual chromoendoscopy score: the PICaSSO (Paddington International Virtual ChromoendoScopy ScOre) in ulcerative colitis.
机构信息
Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Gastroenterology, Biomedical Research Centre and Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom.
Division of Gastroenterology, University of Torino, Torino, Italy.
出版信息
Gastrointest Endosc. 2017 Dec;86(6):1118-1127.e5. doi: 10.1016/j.gie.2017.03.012. Epub 2017 Mar 18.
BACKGROUND AND AIMS
Endoscopic inflammation and healing are important therapeutic endpoints in ulcerative colitis (UC). We developed and validated a new electronic virtual chromoendoscopy (EVC) score that could reflect the full spectrum of mucosal and vascular changes including mucosal healing in UC.
METHODS
Eight participants reviewed a 60-minute training module outlining 3 different i-SCAN modes demonstrating the entire spectrum of inflammatory mucosal and vascular changes in UC. Performance characteristics in endoscopic scoring and predicting the histologic inflammation with EVC (i-SCAN) by using 20 video clips before (pre-test) and after (post-test) were evaluated. Exploratory univariate factor analysis was performed on Paddington International Virtual Chromoendoscopy Score (PICaSSO) covariates for mucosal and vascular score separately. Subsequently, a proportional odds logistic regression model for the prediction of histologic scores was analyzed.
RESULTS
The interobserver agreement for Mayo endoscopic score in the pre-test (κ = .85; 95% CI, .78-.90) and the post-test (κ = .85; 95% CI, .77-.90) evaluation were very good. This was also true for the Ulcerative Colitis Endoscopic Index of Severity in the pre-test and post-test score interobserver agreement (κ = .86; 95% CI, .77-.92; and κ = .84; 95% CI, .75-.91, respectively). The interobserver agreement of the PICaSSO endoscopic score was very good in the pre-test and post-test evaluations (κ = .92; 95% CI, .87-.96; and κ = .89; 95% CI, .84-.94, respectively). The accuracy of the overall PICaSSO in assessing histologic abnormalities and inflammation by Harpaz score was 57% (95% CI, 48%-65%), by Robarts Histological Index 72% (95% CI, 64%-79%), and by the extent, chronicity, activity, plus system (full spectrum of histologic changes) 83% (95% CI, 76%-88%).
CONCLUSIONS
The EVC score "PICaSSO" showed very good interobserver agreement. The new EVC score may be used to define the endoscopic findings of mucosal and vascular healing in UC and reflected the full spectrum of histologic changes.
背景与目的
内镜下炎症和愈合是溃疡性结肠炎（UC）的重要治疗终点。我们开发并验证了一种新的电子虚拟 chromoendoscopy（EVC）评分系统，该系统能够反映 UC 中黏膜和血管变化的全貌，包括黏膜愈合。
方法
8 名参与者回顾了一个 60 分钟的培训模块，该模块概述了 3 种不同的 i-SCAN 模式，展示了 UC 中炎症性黏膜和血管变化的整个范围。评估了内镜评分的性能特征，并使用 20 个视频剪辑在（预测试）之前和（后测试）之后预测 EVC（i-SCAN）的组织学炎症。分别对 Paddington 国际虚拟 chromoendoscopy 评分（PICaSSO）的协变量进行探索性单因素因子分析。随后，对组织学评分的预测进行了比例优势逻辑回归模型分析。
结果
在预测试（κ=0.85；95%CI，0.78-0.90）和后测试（κ=0.85；95%CI，0.77-0.90）中，Mayo 内镜评分的观察者间一致性非常好。溃疡性结肠炎内镜严重程度指数在预测试和后测试评分的观察者间一致性也是如此（κ=0.86；95%CI，0.77-0.92；和κ=0.84；95%CI，0.75-0.91，分别）。在预测试和后测试评估中，PICaSSO 内镜评分的观察者间一致性非常好（κ=0.92；95%CI，0.87-0.96；和κ=0.89；95%CI，0.84-0.94，分别）。总体而言，PICaSSO 评估组织学异常和炎症的 Harpaz 评分的准确性为 57%（95%CI，48%-65%），Robarts 组织学指数为 72%（95%CI，64%-79%），范围、慢性、活动度加系统（全谱组织学变化）为 83%（95%CI，76%-88%）。
结论
EVC 评分“PICaSSO”显示出很好的观察者间一致性。新的 EVC 评分可用于定义 UC 中黏膜和血管愈合的内镜表现，并反映组织学变化的全貌。
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