Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan.
Kaiunbashi Endoscopy Clinic, Iwate, Japan.
Dig Endosc. 2020 Nov;32(7):1066-1073. doi: 10.1111/den.13640. Epub 2020 Feb 25.
Little is known about the usefulness of magnifying endoscopy with crystal violet staining (ME-CV) for the diagnosis of duodenal tumors. We assessed the ability of ME-CV to distinguish Vienna classification (VCL) category 4/5 (C4/5) from category 3 (C3) non-ampullary duodenal epithelial tumors (NADETs).
A total of 76 NADETs were studied. We retrospectively analyzed the diagnostic values of the white light endoscopy (WLE) scoring system and the ME-CV algorithm with receiver operating characteristic (ROC) curves, and three endoscopists calculated the sensitivity, specificity, accuracy, and the area under the curve (AUC) of each. The diagnostic values were tested among NADETs overall and among subgroups of tumors with gastric, gastrointestinal or intestinal mucin phenotypes. Inter-observer agreement of the diagnostic results was also calculated.
According to the VCL, 54 lesions (71.1%) were regarded as C3 and 22 lesions (28.9%) as C4/5. The sensitivity, specificity, accuracy and AUC of ME-CV were higher than those of the WLE scoring system (63.6 vs 54.5, 85.2 vs 75.9, 78.9 vs 69.7, 0.744 vs 0.652, respectively). Inter-observer agreements of the WLE scoring system and ME-CV were both moderate (kappa 0.45 and 0.41). ME-CV had higher sensitivity, specificity, accuracy and AUC than those of the WLE scoring system among the gastric and intestinal phenotypes of NADETs.
ME-CV is appropriate for the diagnosis of C4/5 and C3 NADETs.
对于十二指肠肿瘤的诊断，放大内镜联合结晶紫染色（ME-CV）的作用知之甚少。我们评估了 ME-CV 区分维也纳分类（VCL）第 4/5 类（C4/5）和第 3 类（C3）非壶腹十二指肠上皮肿瘤（NADETs）的能力。
共研究了 76 例 NADETs。我们回顾性分析了白光内镜（WLE）评分系统和 ME-CV 算法的诊断价值，并通过受试者工作特征（ROC）曲线进行分析，三位内镜医师分别计算了每种方法的敏感性、特异性、准确性和曲线下面积（AUC）。在所有 NADETs 以及胃、胃肠或肠型黏液表型肿瘤亚组中测试了这些诊断方法的诊断价值。还计算了诊断结果的观察者间一致性。
根据 VCL，54 个病变（71.1%）被认为是 C3，22 个病变（28.9%）是 C4/5。ME-CV 的敏感性、特异性、准确性和 AUC 均高于 WLE 评分系统（63.6%比 54.5%，85.2%比 75.9%，78.9%比 69.7%，0.744 比 0.652）。WLE 评分系统和 ME-CV 的观察者间一致性均为中度（kappa 值分别为 0.45 和 0.41）。在 NADETs 的胃型和肠型中，ME-CV 的敏感性、特异性、准确性和 AUC 均高于 WLE 评分系统。
ME-CV 适用于 C4/5 和 C3 NADETs 的诊断。
