Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
Gastrointest Endosc. 2018 May;87(5):1318-1323. doi: 10.1016/j.gie.2017.12.021. Epub 2018 Jan 5.
BACKGROUND AND AIMS: Magnifying narrow-band imaging (mag-NBI) and magnifying chromoendoscopy using crystal violet staining for pit pattern analysis (pit pattern) is highly accurate for diagnosing invasion depth of superficial colorectal neoplasms. However, NBI and pit pattern have not been compared. METHODS: We conducted an online survey of endoscopists interested in image-enhanced endoscopy. Still images using white light, mag-NBI, and pit pattern were collected from lesions diagnosed at the National Cancer Center Hospital (NCCH), Tokyo, Japan. Sixty endoscopists from outside NCCH who typically use magnifying endoscopy were recruited for this survey. We assessed the diagnostic accuracy using receiver operating characteristic (ROC) analysis based on a calculation of the area under the ROC curve. RESULTS: One hundred early colorectal neoplasms were selected for this survey. Histopathology revealed that, although 67 of the lesions had high-grade dysplasia or carcinoma with superficial submucosal (SM-s) invasion, the other 33 lesions had a carcinoma with deep submucosal invasion (SM-d). Comparing the area under the ROC curve from mag-NBI with that of pit pattern, the latter showed significantly higher diagnostic accuracy for depth invasion (0.83 [95% CI, 0.81-0.85] for mag-NBI, 0.88 [95% CI, 0.85-0.89] for pit pattern, P = .013). CONCLUSIONS: Pit pattern should be the first choice for diagnosing invasion depth as the most reliable modality rather than mag-NBI.
背景与目的:放大窄带成像(mag-NBI)联合结晶紫染色放大色素内镜下腺管开口形态分析(pit 形态)对诊断结直肠黏膜表面肿瘤的浸润深度具有高度准确性。然而,目前尚未对 NBI 和 pit 形态进行比较。
方法:我们对热衷于图像增强内镜的内镜医师进行了一项在线调查。从日本国家癌症中心医院(NCCH)诊断的病变中采集白光、mag-NBI 和 pit 形态的静态图像。从 NCCH 以外的 60 名常规使用放大内镜的内镜医师中招募了参与本研究的内镜医师。我们基于 ROC 曲线下面积(AUC)的计算进行了诊断准确性评估。
结果:本研究共纳入 100 例早期结直肠肿瘤。组织病理学显示,尽管 67 例病变存在高级别异型增生或黏膜固有层(SM)浅层浸润性癌,但其余 33 例病变为黏膜固有层深层浸润性癌(SM-d)。比较 mag-NBI 和 pit 形态的 AUC,后者对深度浸润的诊断准确性明显更高(mag-NBI 为 0.83[95%CI,0.81-0.85],pit 形态为 0.88[95%CI,0.85-0.89],P=0.013)。
结论:pit 形态应作为诊断浸润深度的首选方法,因其是最可靠的模式,而不是 mag-NBI。
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