Gasrtrointestinal Center and Institute of Minimally-Invasive Endoscopic Care (iMEC), Sano Hospital, Kobe, Japan.
Department of Endoscopy, Hiroshima University, Hiroshima, Japan.
Dig Endosc. 2018 Sep;30(5):642-651. doi: 10.1111/den.13065. Epub 2018 Jun 26.
BACKGROUND AND AIM: The Japan narrow-band imaging (NBI) Expert Team (JNET) was organized to unify four previous magnifying NBI classifications (the Sano, Hiroshima, Showa, and Jikei classifications). The JNET working group created criteria (referred to as the NBI scale) for evaluation of vessel pattern (VP) and surface pattern (SP). We conducted a multicenter validation study of the NBI scale to develop the JNET classification of colorectal lesions. METHODS: Twenty-five expert JNET colonoscopists read 100 still NBI images with and without magnification on the web to evaluate the NBI findings and necessity of the each criterion for the final diagnosis. RESULTS: Surface pattern in magnifying NBI images was necessary for diagnosis of polyps in more than 60% of cases, whereas VP was required in around 90%. Univariate/multivariate analysis of candidate findings in the NBI scale identified three for type 2B (variable caliber of vessels, irregular distribution of vessels, and irregular or obscure surface pattern), and three for type 3 (loose vessel area, interruption of thick vessel, and amorphous areas of surface pattern). Evaluation of the diagnostic performance for these three findings in combination showed that the sensitivity for types 2B and 3 was highest (44.9% and 54.7%, respectively), and that the specificity for type 3 was acceptable (97.4%) when any one of the three findings was evident. We found that the macroscopic type (polypoid or non-polypoid) had a minor influence on the key diagnostic performance for types 2B and 3. CONCLUSION: Based on the present data, we reached a consensus for developing the JNET classification.
背景与目的:日本窄带成像(NBI)专家团队(JNET)成立的目的是统一之前四种放大 NBI 分类(Sano、Hiroshima、Showa 和 Jikei 分类)。JNET 工作组制定了评估血管形态(VP)和表面形态(SP)的标准(称为 NBI 分级)。我们进行了一项多中心验证研究,以开发 JNET 结直肠病变分类。
方法:25 名经验丰富的 JNET 结肠镜检查专家在网上阅读了 100 张放大和不放大的 NBI 静态图像,以评估 NBI 结果和每个标准对最终诊断的必要性。
结果:放大 NBI 图像中的表面形态对于诊断息肉超过 60%的病例是必要的,而 VP 则需要 90%左右。NBI 分级中候选发现的单因素/多因素分析确定了 2B 型的三个(血管口径变化、血管分布不规则和不规则或模糊的表面形态)和 3 型的三个(疏松血管区、厚血管中断和表面形态无定形区)。对这些三种发现联合评估的诊断性能表明,2B 型和 3 型的敏感性最高(分别为 44.9%和 54.7%),当三种发现中的任何一种明显时,3 型的特异性可接受(97.4%)。我们发现,宏观类型(息肉样或非息肉样)对 2B 型和 3 型的关键诊断性能影响较小。
结论:基于目前的数据,我们达成了制定 JNET 分类的共识。
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