Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
Digestion. 2021;102(6):895-902. doi: 10.1159/000516512. Epub 2021 Jun 7.
Endoscopic criteria for the diagnosis of superficial nonampullary duodenal epithelial tumors (SNADETs) are lacking. The aim of this study was to explore the usefulness of endocytoscopy (ECS) in the duodenum.
A total of 77 ECS images stained by methylene blue and 58 images with double staining of methylene blue and crystal violet were obtained from 20 patients. Images were classified into 3 grades based on nuclear and villi atypia: EC A, B, and C. Diagnostic performance of ECS classification to predict histology and interobserver agreement was evaluated. The performance was compared between staining methods and ×520 or ×936 zoom.
With methylene blue staining, high rates of accuracy, sensitivity, specificity, and positive predictive value (PPV) over 90% were achieved for tumor and nontumor diagnosis as assessed by EC A versus EC B. High rates of accuracy, sensitivity, PPV, and negative predictive value over 90% were achieved for the differentiation between the diagnosis of the Vienna category 3 and 4/5 as assessed by EC B versus C. The accuracy rate of interpreting ECS images with ×936 zoom among 10 endoscopists was 82%, and the interobserver agreement rate was 0.803 (Kendall's coefficient of concordance). In the ×936 zoom group, methylene blue staining was significantly associated with higher accuracy rate (odds ratio 1.76 [1.06-2.92], p value 0.0297). No benefit was observed by double staining.
ECS diagnosis with methylene blue provides a high accuracy rate and good interobserver agreement to predict histology of SNADETs.
目前缺乏用于诊断非壶腹型十二指肠黏膜上皮浅表肿瘤（SNADETs）的内镜标准。本研究旨在探讨内镜下细胞学检查（ECS）在十二指肠中的应用价值。
从 20 例患者中获得了 77 张亚甲蓝染色的 ECS 图像和 58 张亚甲蓝和结晶紫双重染色的 ECS 图像。根据细胞核和绒毛异型性将图像分为 3 个等级：EC A、B 和 C。评估 ECS 分类预测组织学和观察者间一致性的诊断性能，并比较了染色方法和 ×520 或 ×936 放大倍数之间的性能。
采用亚甲蓝染色时，EC A 与 EC B 相比，肿瘤和非肿瘤诊断的准确率、敏感度、特异度和阳性预测值（PPV）均超过 90%。EC B 与 C 相比，用于区分维也纳分类 3 和 4/5 诊断的准确率、敏感度、PPV 和阴性预测值均超过 90%。10 名内镜医师对 ×936 放大倍数下的 ECS 图像的判读准确率为 82%，观察者间一致性率为 0.803（肯德尔协和系数）。在 ×936 放大倍数组中，亚甲蓝染色与更高的准确率显著相关（优势比 1.76 [1.06-2.92]，p 值为 0.0297）。双重染色没有带来益处。
亚甲蓝染色的 ECS 诊断可提供较高的准确率和良好的观察者间一致性，有助于预测 SNADETs 的组织学特征。
