Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
General Surgery Department, Nine Division Hospital of Xinjiang Production and Construction Corps, Tacheng, Xinjiang Uygur Autonomous Region, China.
J Dig Dis. 2019 Mar;20(3):135-142. doi: 10.1111/1751-2980.12706.
Sessile serrated adenoma/polyps (SSA/P) are recognized as precancerous lesions in the colon and resemble hyperplastic polyps (HP). Definite endoscopic features under narrow band imaging (NBI) with or without magnification may help differentiate these two lesions. Our study aimed to identify specific endoscopic features of SSA/P by NBI.
A total of 199 patients with histopathologically proven colorectal SSA/P or HP after a polypectomy were enrolled. Magnifying and non-magnifying NBI pictures of 206 matching lesions were evaluated by one expert and two non-expert endoscopists using various endoscopic characteristics retrospectively.
Multivariate analysis indicated that a clouded surface (odds ratio [OR] 6.48, 95% confidence interval [CI] 2.72-15.44, P = 0.000) and dilated and branching vessels (DBV) (OR 7.95, 95% CI 3.71-17.02, P = 0.000) were significant endoscopic features for diagnosing SSA/P compared with HP. The combination of these two features could improve diagnostic specificity to 96%, and the area under the receiver operating characteristic curve was 0.749. However, it seemed that the presence of dark spots (OR 1.93, 95% CI 0.94-4.00, P = 0.075) was not a definite feature in differentiating these two lesions. Neither a mucus cap nor CP-II meshed capillary vessels showed statistical significance in differentiating SSA/P from HP (P = 0.590 and 0.293, respectively).
A clouded surface and DBV were two indicators for diagnosing SSA/P. Combining these two factors together under NBI with or without magnification achieved better diagnostic performance than when they were used alone.
无蒂锯齿状腺瘤/息肉（SSA/P）被认为是结肠的癌前病变，类似于增生性息肉（HP）。窄带成像（NBI）下具有或不具有放大功能的明确内镜特征可能有助于区分这两种病变。我们的研究旨在通过 NBI 确定 SSA/P 的特定内镜特征。
共纳入 199 例经息肉切除术后病理证实为结直肠 SSA/P 或 HP 的患者。1 名专家和 2 名非专家内镜医师回顾性地评估了 206 个匹配病变的放大和非放大 NBI 图像，使用各种内镜特征进行评估。
多变量分析表明，云雾状表面（比值比 [OR] 6.48，95%置信区间 [CI] 2.72-15.44，P=0.000）和扩张分支血管（DBV）（OR 7.95，95%CI 3.71-17.02，P=0.000）是诊断 SSA/P 与 HP 相比的显著内镜特征。这两个特征的结合可将诊断特异性提高到 96%，受试者工作特征曲线下面积为 0.749。然而，似乎存在暗点（OR 1.93，95%CI 0.94-4.00，P=0.075）并不是区分这两种病变的明确特征。黏液帽或 CP-II 网格状毛细血管均不能在区分 SSA/P 与 HP 方面显示出统计学意义（P=0.590 和 0.293）。
云雾状表面和 DBV 是诊断 SSA/P 的两个指标。在 NBI 下结合使用这两个因素（无论是否放大）比单独使用这两个因素具有更好的诊断性能。
