Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China.
Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China.
Sci Rep. 2020 Dec 16;10(1):22032. doi: 10.1038/s41598-020-78708-1.
This prospective study was aimed to evaluate the clinical value of narrow-band imaging (NBI), magnification endoscopy with narrow-band imaging (NBIME) and magnification endoscopy with acetic acid enhancement and narrow-band imaging (AA-NBIME) in the diagnosis of small colorectal polyps. We studied 261 small colorectal polyps from 122 patients with the use of above three techniques. Lesions were resected for histopathological analysis. The endoscopic images were independently reviewed by three experts and three non-experts and the diagnostic accuracy and image definition were compared among the modalities. The "experts-agreed" diagnostic accuracy was 87.7% for NBI versus 91.6% for NBIME versus 94.6% for AA-NBIME. The "non-experts-agreed" diagnostic accuracy was 80.1% for NBI versus 84.3% for NBIME versus 89.3% for AA-NBIME. All experts and non-experts diagnosed the small colorectal polyps statistically more accurately with AA-NBIME than NBI (P < 0.05). In all three modalities, the expert group's diagnostic accuracies were statistically significantly higher compared with the non-expert group. For experts, the Kappa values for AA-NBIME, NBIME and NBI diagnosis were 0.962 (0.892-1.032), 0.577 (0.507-0.647) and 0.567 (0.497-0.637), respectively; while for nonexperts, 0.818 (0.748-0.888), 0.532 (0.462-0.602) and 0.530 (0.460-0.600). This demonstrated a good reproducibility of AA-NBIME diagnosis. The average scores (experts and non-experts) of images acquired using AA-NBIME were significantly higher than those acquired using NBIME and ME (P < 0.05). AA-NBIME is a promising tool to clearly visualize the mucosal pit pattern (PP) of colorectal polyps for better differentiating neoplastic polyps from non-neoplastic ones.
这项前瞻性研究旨在评估窄带成像（NBI）、窄带成像放大内镜（NBIME）和醋酸增强窄带成像放大内镜（AA-NBIME）在诊断小结直肠息肉中的临床价值。我们使用上述三种技术研究了 122 例患者的 261 个小结直肠息肉。对病变进行切除以进行组织病理学分析。内镜图像由三位专家和三位非专家独立进行审查，并比较了这些方法的诊断准确性和图像清晰度。NBI 的“专家一致”诊断准确率为 87.7%，NBIME 为 91.6%，AA-NBIME 为 94.6%。NBI 的“非专家一致”诊断准确率为 80.1%，NBIME 为 84.3%，AA-NBIME 为 89.3%。所有专家和非专家均认为 AA-NBIME 比 NBI 更准确地诊断小结直肠息肉（P<0.05）。在所有三种模式下，专家组的诊断准确率均明显高于非专家组。对于专家来说，AA-NBIME、NBIME 和 NBI 诊断的 Kappa 值分别为 0.962（0.892-1.032）、0.577（0.507-0.647）和 0.567（0.497-0.637）；而非专家的 Kappa 值分别为 0.818（0.748-0.888）、0.532（0.462-0.602）和 0.530（0.460-0.600）。这表明 AA-NBIME 诊断具有良好的可重复性。使用 AA-NBIME 获取的图像平均得分（专家和非专家）明显高于使用 NBIME 和 ME 获取的图像（P<0.05）。AA-NBIME 是一种很有前途的工具，可清晰显示结直肠息肉的黏膜腺管开口形态（PP），从而更好地区分肿瘤性息肉和非肿瘤性息肉。
