Pu Leonardo Zorrón Cheng Tao, Cheong Kuan Loong, Koay Doreen Siew Ching, Yeap Sze Pheh, Ovenden Amanda, Raju Mahima, Ruszkiewicz Andrew, Chiu Philip W, Lau James Y, Singh Rajvinder
Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, SA 5112, Australia.
Medical School, University of Adelaide, Adelaide, SA 5005, Australia.
World J Gastrointest Endosc. 2018 Sep 16;10(9):210-218. doi: 10.4253/wjge.v10.i9.210.
To assess the utility of modified Sano's (MS) the narrow band imaging international colorectal endoscopic (NICE) classification in differentiating colorectal polyps.
Patients undergoing colonoscopy between 2013 and 2015 were enrolled in this trial. Based on the MS or the NICE classifications, patients were randomised for real-time endoscopic diagnosis. This was followed by biopsies, endoscopic or surgical resection. The endoscopic diagnosis was then compared to the final (blinded) histopathology. The primary endpoint was the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of differentiating neoplastic and non-neoplastic polyps (MS II/IIo / IIIa / IIIb I or NICE 1 2/3). The secondary endpoints were "endoscopic resectability" (MS II/IIo/IIIa I/IIIb or NICE 2 1/3), NPV for diminutive distal adenomas and prediction of post-polypectomy surveillance intervals.
A total of 348 patients were evaluated. The Sn, Sp, PPV and NPV in differentiating neoplastic polyps from non-neoplastic polyps were, 98.9%, 85.7%, 98.2% and 90.9% for MS; and 99.1%, 57.7%, 95.4% and 88.2% for NICE, respectively. The area under the receiver operating characteristic curve (AUC) for MS was 0.92 (95%CI: 0.86-0.98); and AUC for NICE was 0.78 (95%CI: 0.69, 0.88). The Sn, Sp, PPV and NPV in predicting "endoscopic resectability" were 98.9%, 86.1%, 97.8% and 92.5% for MS; and 98.6%, 66.7%, 94.7% and 88.9% for NICE, respectively. The AUC for MS was 0.92 (95%CI: 0.87-0.98); and the AUC for NICE was 0.83 (95%CI: 0.75-0.90). The AUC values were statistically different for both comparisons ( 0.0165 and 0.0420, respectively). The accuracy for diagnosis of sessile serrated adenoma/polyp (SSA/P) with high confidence utilizing MS classification was 93.2%. The differentiation of SSA/P from other lesions achieved Sp, Sn, PPV and NPV of 87.2%, 91.5%, 89.6% and 98.6%, respectively. The NPV for predicting adenomas in diminutive rectosigmoid polyps ( = 150) was 96.6% and 95% with MS and NICE respectively. The calculated accuracy of post-polypectomy surveillance for MS group was 98.2% (167 out of 170) and for NICE group was 92.1% (139 out of 151).
The MS classification outperformed the NICE classification in differentiating neoplastic polyps and predicting endoscopic resectability. Both classifications met ASGE PIVI thresholds.
评估改良佐野（MS）分类法及窄带成像国际结直肠内镜（NICE）分类法在鉴别结直肠息肉方面的效用。
纳入2013年至2015年间接受结肠镜检查的患者。根据MS或NICE分类法，将患者随机分组以进行实时内镜诊断。随后进行活检、内镜或手术切除。然后将内镜诊断结果与最终（盲法）组织病理学结果进行比较。主要终点是鉴别肿瘤性和非肿瘤性息肉（MS II/IIo / IIIa / IIIb 与 I 或 NICE 1 与 2/3）的敏感性（Sn）、特异性（Sp）、阳性预测值（PPV）和阴性预测值（NPV）。次要终点是“内镜可切除性”（MS II/IIo/IIIa 与 I/IIIb 或 NICE 2 与 1/3）、微小远端腺瘤的NPV以及息肉切除术后监测间隔的预测。
共评估了348例患者。MS分类法鉴别肿瘤性息肉与非肿瘤性息肉的Sn、Sp、PPV和NPV分别为98.9%、85.7%、98.2%和90.9%；NICE分类法的分别为99.1%、57.7%、95.4%和88.2%。MS分类法的受试者操作特征曲线（AUC）下面积为0.92（95%CI：0.86 - 0.98）；NICE分类法的AUC为0.78（95%CI：0.69, 0.88）。MS分类法预测“内镜可切除性”的Sn、Sp、PPV和NPV分别为98.9%、86.1%、97.8%和92.5%；NICE分类法的分别为98.6%、66.7%、94.7%和88.9%。MS分类法的AUC为0.92（95%CI：0.87 - 0.98）；NICE分类法的AUC为0.83（95%CI：0.75 - 0.90）。两种比较的AUC值均有统计学差异（分别为 0.0165 和 0.0420）。使用MS分类法高置信度诊断无蒂锯齿状腺瘤/息肉（SSA/P）的准确率为93.2%。SSA/P与其他病变的鉴别中，Sp、Sn、PPV和NPV分别为87.2%、91.5%、89.6%和98.6%。MS和NICE分类法预测微小直肠乙状结肠息肉（≤15mm）中腺瘤的NPV分别为96.6%和95%。MS组息肉切除术后监测的计算准确率为98.2%（170例中的167例），NICE组为92.1%（151例中的139例）。
在鉴别肿瘤性息肉和预测内镜可切除性方面，MS分类法优于NICE分类法。两种分类法均符合美国胃肠内镜学会PIVI阈值。
