Bustamante-Balén Marco, Satorres Carla, Ramos-Soler David, García-Campos Maria, Alonso Noelia, Ponce Marta, Argüello-Viudez Lidia, Giner Francisco, Ferrer-Lozano Jaime, Pons-Beltrán Vicente
Gastrointestinal Endoscopy Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Gastrointestinal Research Group, Health Research Institute (IISLaFe), Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Endosc Int Open. 2021 Jan;9(1):E14-E21. doi: 10.1055/a-1293-7086. Epub 2021 Jan 1.
We aimed to describe the presence and combination of Hazewinkel's optical diagnosis (OD) criteria for sessile serrated lesions (SSL), determining which lesion characteristics increase the probability of a correct OD, with a focus on diminutive lesions. This was a prospective study describing the presence of Hazewinkel's OD criteria for SSL in lesions found in consecutive CRC screening colonoscopies. The presence of each OD criterion and their diagnostic combinations in SSL, related to the lesion's NBI International Colorectal Endoscopic (NICE) classification category, size, and location, were described. The presence of two or more optical criteria was considered diagnostic of SSL. The OD was compared to pathology as the gold standard. Seventy-nine SSLs (5.6 %) were diagnosed. Cloud-like appearance was the most prevalent OD criterion (35, 44.3 %). OD criteria were more frequently identified in NICE type 1, ≥ 10 mm, and proximal lesions. Only 26 SLLs fulfilled the OD criteria (sensitivity 32.9 %, 95 % CI 29.1 %-36.7 %). The sensitivity for diminutive SSL was 14.7 %, (95 % CI 11.9 %-17.6 %). Eighty-five lesions were optically diagnosed as SSL. However, only in 26 SSL was this the definitive diagnosis (positive predictive value 30.6 %, 95 % CI 26.9 %-34.3 %). Size > 5 mm and proximal location increased the probability of a correct diagnosis. The overall accuracy of the optical criteria was 92.0 % (95 % CI, 89.8 %-94.2 %). The Hazewinkel's optical criteria are not reliable for a positive diagnosis of SSL, particularly for diminutive lesions.
我们旨在描述用于无蒂锯齿状病变（SSL）的哈泽温克尔光学诊断（OD）标准的存在情况及组合方式，确定哪些病变特征会增加正确进行光学诊断的概率，重点关注微小病变。这是一项前瞻性研究，描述了在连续的结直肠癌筛查结肠镜检查中发现的病变里哈泽温克尔SSL的OD标准的存在情况。描述了与病变的窄带成像国际结直肠内镜（NICE）分类类别、大小和位置相关的每个OD标准及其在SSL中的诊断组合情况。存在两个或更多光学标准被视为可诊断为SSL。将光学诊断与作为金标准的病理诊断进行比较。共诊断出79例SSL（5.6%）。云雾状外观是最常见的OD标准（35例，44.3%）。OD标准在NICE 1型、≥10mm及近端病变中更常被发现。只有26例SLL符合OD标准（敏感性32.9%，95%置信区间29.1%-36.7%）。微小SSL的敏感性为14.7%（95%置信区间11.9%-17.6%）。有85个病变被光学诊断为SSL。然而，只有26例SSL最终确诊为此病（阳性预测值30.6%，95%置信区间26.9%-34.3%）。大小>5mm及近端位置增加了正确诊断的概率。光学标准的总体准确率为92.0%（95%置信区间89.8%-94.2%）。哈泽温克尔光学标准对SSL的阳性诊断不可靠，尤其是对微小病变。
