Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa.
Medicine Department, Universitat Internacional de Catalunya, Barcelona.
Curr Opin Gastroenterol. 2019 Sep;35(5):432-439. doi: 10.1097/MOG.0000000000000570.
The detection of early colorectal cancer has improved notably since the introduction of bowel cancer screening programmes. This has created new challenges from endoscopic, histological and therapeutic perspectives. Here, we outline the limitations of current clinical practice and ways of implementing optical diagnosis to overcome these limitations.
Virtual chromoendoscopy without magnification for predicting or ruling out deep submucosal invasion is useful in real clinical practice for most lesions. However, magnifying virtual chromoendoscopy is needed to make an accurate diagnosis in nonulcerated narrow-band imaging international colorectal endoscopic (NICE) type 3 lesions or NICE type 2 lesions with depressed areas or of nodular mixed type. Finally, dye-based magnifying chromoendoscopy is needed in Japanese NBI Expert Team 2B lesions assessed with magnifying virtual chromoendoscopy.
A four-step strategy is proposed, combining white-light assessment, virtual chromoendoscopy without magnification, virtual chromoendoscopy with magnification and dye-based chromoendoscopy with magnification.
自结直肠癌筛查项目开展以来，早期结直肠癌的检测显著改善。这从内镜、组织学和治疗的角度带来了新的挑战。在这里，我们概述了当前临床实践的局限性以及实施光学诊断以克服这些局限性的方法。
非放大虚拟染色内镜在预测或排除深层黏膜下浸润方面对大多数病变具有实用价值。然而，对于非溃疡性窄带成像国际结直肠内镜（NICE）3 型病变或凹陷区或结节混合型 NICE 2 型病变，需要放大虚拟染色内镜来进行准确诊断。最后，对于经放大虚拟染色内镜评估的日本 NBI 专家团队 2B 病变，需要进行基于染料的放大染色内镜检查。
提出了一个四步策略，结合白光评估、非放大虚拟染色内镜、放大虚拟染色内镜和基于染料的放大染色内镜。
