使用日本窄带成像专家团队（JNET）分类法的放大窄带成像（NBI）用于诊断局限性结直肠病变
Magnifying Narrow Band Imaging (NBI) for the Diagnosis of Localized Colorectal Lesions Using the Japan NBI Expert Team (JNET) Classification.
作者信息
Komeda Yoriaki, Kashida Hiroshi, Sakurai Toshiharu, Asakuma Yutaka, Tribonias George, Nagai Tomoyuki, Kono Masashi, Minaga Kosuke, Takenaka Mamoru, Arizumi Tadaaki, Hagiwara Satoru, Matsui Shigenaga, Watanabe Tomohiro, Nishida Naoshi, Chikugo Takaaki, Chiba Yasutaka, Kudo Masatoshi
机构信息
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
出版信息
Oncology. 2017;93 Suppl 1:49-54. doi: 10.1159/000481230. Epub 2017 Dec 20.
OBJECTIVE
The Japan NBI Expert Team (JNET) proposed a new narrow band imaging (NBI) classification system for colorectal tumors in June 2014. In this classification system, types 1, 2A, 2B, and 3 correspond to hyperplastic polyps (HPs) including sessile serrated polyps (SSPs), low-grade dysplasia (LGD), high-grade dysplasia (HGD) to shallow submucosal invasive (SM-s) carcinomas, and deep submucosal invasive (SM-d) carcinomas, respectively.
METHODS
To validate this system, we performed a retrospective image evaluation study, in which 199 colorectal tumors previously assessed by NBI magnifying endoscopy were classified by 3 blinded experienced colonoscopists using the JNET system. The results were compared with the final pathological diagnoses to determine the JNET classification's accuracy. The interobserver agreement was calculated, and the intraobserver agreement was assessed after 6 months.
RESULTS
The final pathological diagnoses identified 14 HPs/SSPs, 127 LGDs, 22 HGDs, 19 SM-s carcinomas, and 17 SM-d carcinomas. The respective sensitivities, specificities, positive predictive value, negative predictive value, and accuracies were as follows: Type 1, 85.7, 99.5, 92.3, 98.9, and 98.5%; Type 2A, 96.0, 81.9, 90.3, 92.1, and 90.9%; Type 2B, 75.6%, 90.5, 67.3, 93.4, and 87.4%; and Type 3, 29.4%, 100, 100, 93.8, and 94.0%. The interobserver agreement and the intraobserver agreement were moderate (κ value: 0.52) and excellent (κ value: 0.88), respectively. Lesions presenting as Type 2B during NBI comprised a range of colorectal tumors, including HGDs, SM-s, and SM-d.
CONCLUSIONS
The JNET classification was useful for the diagnosis of HPs/SSPs, LGDs, and SM-d, but not SM-s lesions. For low-confidence cases, magnified chromoendoscopy is recommended to ensure correct diagnoses.
目的
日本窄带成像专家团队（JNET）于2014年6月提出了一种用于结直肠肿瘤的新窄带成像（NBI）分类系统。在该分类系统中，1型、2A 型、2B 型和3型分别对应增生性息肉（HP），包括无蒂锯齿状息肉（SSP）、低级别异型增生（LGD）、高级别异型增生（HGD）至浅黏膜下浸润（SM-s）癌以及深黏膜下浸润（SM-d）癌。
方法
为验证该系统，我们进行了一项回顾性图像评估研究，199例先前经NBI放大内镜评估的结直肠肿瘤由3名经验丰富的盲法结肠镜检查医师使用JNET系统进行分类。将结果与最终病理诊断进行比较，以确定JNET分类的准确性。计算观察者间一致性，并在6个月后评估观察者内一致性。
结果
最终病理诊断确定14例HP/SSP、127例LGD、22例HGD、19例SM-s癌和17例SM-d癌。各类型的敏感性、特异性、阳性预测值、阴性预测值和准确性如下：1型，分别为85.7%、99.5%、92.3%、98.9%和98.5%；2A型，分别为96.0%、81.9%、90.3%、92.1%和90.9%；2B型，分别为75.6%、90.5%、67.3%、93.4%和87.4%；3型，分别为29.4%、100%、100%、93.8%和94.0%。观察者间一致性为中等（κ值：0.52），观察者内一致性为优秀（κ值：0.88）。NBI检查时表现为2B型的病变包括一系列结直肠肿瘤，如HGD、SM-s和SM-d。
结论
JNET分类对HP/SSP、LGD和SM-d的诊断有用，但对SM-s病变无用。对于低置信度病例，建议进行放大染色内镜检查以确保正确诊断。
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