Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia.
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Gastrointest Endosc. 2022 Mar;95(3):527-534.e2. doi: 10.1016/j.gie.2021.11.032. Epub 2021 Dec 5.
Detailed lesion assessment of large nonpedunculated colorectal polyps (LNPCPs; ≥20 mm) can help predict the risk of submucosal invasive cancer (SMIC). Traditionally this has required the use of dye-based chromoendoscopy (DBC). We sought to assess the accuracy and incremental benefit of DBC in addition to high-definition white-light imaging (HDWLI) and virtual chromoendoscopy (VCE) for the prediction of SMIC within LNPCPs.
A prospective observational study of consecutive LNPCPs at a single tertiary referral center was performed. Before resection all lesions were assessed for the presence of a demarcated area (DA), defined as an area of disordered pit or microvascular pattern, by 2 trained endoscopists before and after DBC. Diagnostic performance characteristics were calculated with histology as the reference criterion standard, and overall agreement was calculated using the κ statistic.
Over 39 months to March 2021, 400 consecutive LNPCPs (median lesion size, 35 mm; interquartile range, 25-45) were analyzed. The overall rate of SMIC was 6.5%. Presence of a DA had an accuracy of 91% (95% confidence interval, 87.7-93.5) for SMIC, independent of the use of DBC. The rate of interobserver agreement for presence of a DA using HDWLI + VCE was very high (κ = .96) with no benefit gained by the addition of DBC.
The use of HDWLI and VCE is likely to be adequate for lesion assessment for the prediction of SMIC among LNPCPs. Further, the absence of a DA is strongly predictive for the absence of SMIC, independent to the use of DBC. (Clinical trial registration number: NCT03506321.).
对大型无蒂结直肠息肉（LNPCP；≥20mm）进行详细的病变评估有助于预测黏膜下浸润性癌（SMIC）的风险。传统上，这需要使用基于染料的染色内镜（DBC）。我们旨在评估 DBC 联合高清白光成像（HDWLI）和虚拟染色内镜（VCE）在预测 LNPCP 内 SMIC 方面的准确性和附加获益。
对单中心的连续 LNPCP 进行了一项前瞻性观察研究。在切除前，两名经过培训的内镜医生分别在 DBC 前后评估所有病变是否存在界限清晰的区域（DA），DA 定义为紊乱的腺窝或微血管模式区域。使用组织学作为参考标准计算诊断性能特征，并使用κ 统计量计算总体一致性。
截至 2021 年 3 月，共分析了 39 个月内的 400 例连续 LNPCP（中位病变大小为 35mm；四分位间距为 25-45mm）。SMIC 的总体发生率为 6.5%。DA 的存在对 SMIC 的准确性为 91%（95%置信区间，87.7%-93.5%），与 DBC 的使用无关。使用 HDWLI+VCE 评估 DA 存在的观察者间一致性非常高（κ=0.96），而添加 DBC 并不能带来获益。
对于预测 LNPCP 中的 SMIC，使用 HDWLI 和 VCE 进行病变评估可能已经足够。此外，DA 的不存在强烈提示 SMIC 不存在，而与 DBC 的使用无关。（临床试验注册号：NCT03506321.）。
