Divisions of, Division of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.
Division of, Diagnostic Pathology, NTT Medical Center Tokyo, Tokyo, Japan.
Dig Endosc. 2021 Mar;33(3):399-407. doi: 10.1111/den.13762. Epub 2020 Aug 28.
Differentiating superficial non-ampullary duodenal epithelial tumors (SNADETs) that harbor malignant potential is important. We developed a simple scoring system and investigated whether it enables the differentiation of low-grade adenoma and high-grade adenoma/adenocarcinoma.
We retrospectively enrolled 197 consecutive patients with 207 SNADETs who underwent endoscopic resection at NTT Medical Center Tokyo between March 2016 and May 2019. Endoscopic findings were compared between Vienna Classification (VCL) C3 and C4/5 lesions. A multivariate logistic regression analysis was performed to develop a scoring system to identify VCL C4/5 lesions. The efficacy of our scoring system was elucidated among five novice and five expert endoscopists.
Of 207 SNADETs, 66 and 141 lesions were pathologically diagnosed as VCL C3 and C4/5. A multivariate logistic regression analysis identified a tumor diameter of 10-19 mm (OR, 3.81; 95% CI, 1.02-14.2; P = 0.04), a tumor diameter ≥20 mm (OR, 95.2; 95% CI, 10.4-871.0; P < 0.001), a red color (OR, 14.5; 95% CI, 3.55-59.6; P < 0.001), the presence of irregular surface pattern (OR, 12.4; 95% CI, 3.00-51.4; P < 0.001), and the presence of irregular vessel pattern (OR, 13.7; 95% CI, 4.03-46.6; P < 0.001) as independent significant predictors of VCL C4/5. Considering these results, we developed a scoring system. Using an appropriate cutoff value, the diagnostic accuracy, sensitivity and specificity were calculated as 92%, 95% and 93%. The average diagnostic accuracy did not differ between novice and expert endoscopists (86% vs 87%, P = 0.76).
Our scoring system was useful for differentiating VCL C3 and C4/5 lesions. UMIN Clinical Trials (No. 000039063).
区分具有恶性潜能的浅表非壶腹十二指肠上皮肿瘤（SNADETs）非常重要。我们开发了一种简单的评分系统，并研究了其是否能够区分低级别腺瘤和高级别腺瘤/腺癌。
我们回顾性纳入了 2016 年 3 月至 2019 年 5 月期间在 NTT 医疗中心东京接受内镜下切除的 197 例连续 207 例 SNADETs 患者。比较维也纳分类（VCL）C3 和 C4/5 病变的内镜表现。采用多变量逻辑回归分析建立评分系统以识别 VCL C4/5 病变。在五名新手和五名专家内镜医生中阐明了我们评分系统的疗效。
在 207 例 SNADETs 中，66 例和 141 例病理诊断为 VCL C3 和 C4/5。多变量逻辑回归分析确定肿瘤直径为 10-19mm（OR，3.81；95%CI，1.02-14.2；P=0.04）、肿瘤直径≥20mm（OR，95.2；95%CI，10.4-871.0；P<0.001）、红色（OR，14.5；95%CI，3.55-59.6；P<0.001）、不规则表面模式（OR，12.4；95%CI，3.00-51.4；P<0.001）和不规则血管模式（OR，13.7；95%CI，4.03-46.6；P<0.001）是 VCL C4/5 的独立显著预测因子。考虑到这些结果，我们开发了一个评分系统。使用适当的截断值，计算出诊断准确性、敏感性和特异性分别为 92%、95%和 93%。新手和专家内镜医生的平均诊断准确性无差异（86%vs87%，P=0.76）。
我们的评分系统可用于区分 VCL C3 和 C4/5 病变。UMIN 临床试验（注册号：000039063）。
