Zorron Cheng Tao Pu Leonardo, Yamamura Takeshi, Nakamura Masanao, Koay Doreen S C, Ovenden Amanda, Edwards Suzanne, Burt Alastair D, Hirooka Yoshiki, Fujishiro Mitsuhiro, Singh Rajvinder
Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia.
Department of Gastroenterology and Hepatology Nagoya University Nagoya Japan.
JGH Open. 2020 Jul 7;4(5):818-826. doi: 10.1002/jgh3.12382. eCollection 2020 Oct.
Commonly used classifications for colorectal lesions (CLs) include the Narrow Band Imaging (NBI) International Colorectal Endoscopic (NICE) and Japan NBI Expert Team (JNET) classifications. However, both lack a sessile serrated adenoma/polyp (SSA/P) category. This has been addressed by the modified Sano's (MS) and Workgroup serrAted polypS and Polyposis (WASP) classifications. This study aims to compare the accuracy of wNICE and wJNET (WASP added to both) with the stand-alone MS classification.
Patients undergoing colonoscopy at an Australian tertiary hospital who had at least one CL detected were prospectively enrolled. In the exploratory phase, CLs were characterized in real time with NBI and magnification using all classifications. In the validation phase, CLs were assessed with both NBI and Blue Laser Imaging (BLI) by four external endoscopists in Japan. The primary outcome was the comparison of wJNET and MS. Secondary outcomes included comparisons among all classifications and the calculation of interrater reliability.
A total of 483 CLs were evaluated in real time in the exploratory phase, and four sets of 30 CL images (80 on NBI and 40 on BLI) were scored in the validation phase. For high-confidence diagnoses, MS accuracy was superior to wJNET in both the exploratory (86% 79%, < 0.05) and validation (85% 69%, < 0.05) phases. The interrater reliability was substantial for all classifications ( = 0.74, 0.69, and 0.63 for wNICE, wJNET, and MS, respectively).
MS classification achieved the highest accuracy in both the exploratory and validation phases. MS can differentiate serrated and adenomatous polyps as a stand-alone classification.
结直肠病变（CLs）常用的分类方法包括窄带成像（NBI）国际结直肠内镜（NICE）分类和日本NBI专家团队（JNET）分类。然而，这两种分类都缺乏无蒂锯齿状腺瘤/息肉（SSA/P）类别。改良的佐野（MS）分类和锯齿状息肉及息肉病工作组（WASP）分类解决了这一问题。本研究旨在比较添加了WASP的wNICE和wJNET与单独的MS分类的准确性。
前瞻性纳入在澳大利亚一家三级医院接受结肠镜检查且至少检测到一个CLs的患者。在探索阶段，使用所有分类方法通过NBI和放大内镜实时对CLs进行特征描述。在验证阶段，由日本的四名外部内镜医师使用NBI和蓝光成像（BLI）对CLs进行评估。主要结局是比较wJNET和MS。次要结局包括所有分类方法之间的比较以及评估者间可靠性的计算。
在探索阶段共实时评估了483个CLs，在验证阶段对四组共30个CL图像（NBI上80个，BLI上40个）进行了评分。对于高置信度诊断，在探索阶段（86%对79%，P<0.05）和验证阶段（85%对69%，P<0.05），MS的准确性均优于wJNET。所有分类方法的评估者间可靠性都很高（wNICE、wJNET和MS的κ值分别为0.74、0.69和0.63）。
MS分类在探索阶段和验证阶段均达到了最高准确性。MS作为一种单独的分类方法能够区分锯齿状息肉和腺瘤性息肉。
