Cheng Weiwei, Liu Haifeng, Gu Zhujun, Hu Zhihong, Wang Ling, Wang Xing
Department of Gastroenterology, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China.
Medicine (Baltimore). 2017 May;96(19):e6671. doi: 10.1097/MD.0000000000006671.
Using narrow-band imaging (NBI), the micro morphology of polyp surfaces was visualized at high resolution when the contrast between the lesions and the surrounding tissue areas was intensified. The objective of the study was to compare NBI and conventional white light endoscopy (C-WLI) for diagnostic efficacy and treatment of children with Peutz-Jeghers syndrome (PJS), a rare autosomal dominant-genetic disease.We retrospectively analyzed the clinical data of 18 patients diagnosed with PJS and 72 diagnosed with juvenile polyps during the same time period. Endoscopy was used to observe the morphology of polyps, which were classified according to the Kudo pit pattern. Eighty-two and 76 polyps were resected using endoscopy from PJS and juvenile polyp patients, respectively, and pathologically examined for comparison with NBI or C-WLI endoscopic observations.With NBI, 57 (69.5%) type I, 10 (12.2%) type II, and 13 (15.9%) type III polyps were identified in 82 (100%) polyps excised from 18 PJS patients, whereas 69 (88.5%) type I, 5 (6.4%) type II and 4 (5.1%) type III were identified in 78 (100%) of polyps removed from 72 juvenile polyp patients. The combined ratios of types II and III were higher in PJS (28.1%) than in juvenile polyp patients (11.5%). Pathological diagnosis identified 69 of 82 PJS polyps as hamartoma and 13 as adenoma, whereas NBI detected 10 adenomas and C-WLI only 4. The sensitivity, specificity, and accuracy of NBI in the diagnosis of adenoma were 76.9%, 97.1%, and 93.9%, respectively, whereas those of C-WLI were 30.8%, 94.2%, and 84.1%.NBI endoscopy had higher sensitivity and specificity than C-WLI for the diagnosis of adenomatous polyps and is recommended for the diagnosis, characterization, and resection of polyps in children with PJS.
使用窄带成像（NBI）时，当病变与周围组织区域之间的对比度增强，息肉表面的微观形态可以高分辨率显示。本研究的目的是比较NBI和传统白光内镜检查（C-WLI）对患有黑斑息肉综合征（PJS）儿童的诊断效果和治疗情况，PJS是一种罕见的常染色体显性遗传病。我们回顾性分析了18例诊断为PJS的患者和同期72例诊断为幼年息肉患者的临床资料。采用内镜观察息肉形态，并根据工藤凹坑模式进行分类。分别从PJS患者和幼年息肉患者中通过内镜切除82个和76个息肉，并进行病理检查以与NBI或C-WLI内镜观察结果进行比较。在从18例PJS患者切除的82个（100%）息肉中，通过NBI识别出57个（69.5%）I型、10个（12.2%）II型和13个（15.9%）III型息肉，而在从72例幼年息肉患者切除的78个（100%）息肉中，识别出69个（88.5%）I型、5个（6.4%）II型和4个（5.1%）III型息肉。PJS患者中II型和III型的合并比例（28.1%）高于幼年息肉患者（11.5%）。病理诊断将82个PJS息肉中的69个诊断为错构瘤，13个诊断为腺瘤，而NBI检测到10个腺瘤，C-WLI仅检测到4个。NBI诊断腺瘤的敏感性、特异性和准确性分别为76.9%、97.1%和93.9%，而C-WLI的分别为30.8%、94.2%和84.1%。NBI内镜检查在诊断腺瘤性息肉方面比C-WLI具有更高的敏感性和特异性，建议用于PJS儿童息肉的诊断、特征描述和切除。
