醋酸染色放大内镜及窄带成像在十二指肠肿瘤诊断中的应用：诊断算法的提出
Usefulness of magnifying endoscopy with acetic acid and narrow-band imaging for the diagnosis of duodenal neoplasms: proposal of a diagnostic algorithm.
作者信息
Miura Hiroshi, Tanaka Kyosuke, Umeda Yuhei, Ikenoyama Yohei, Yukimoto Hiroki, Hamada Yasuhiko, Yamada Reiko, Tsuboi Junya, Nakamura Misaki, Katsurahara Masaki, Horiki Noriyuki, Nakagawa Hayato
机构信息
Department of Endoscopy, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan.
出版信息
Surg Endosc. 2022 Nov;36(11):8086-8095. doi: 10.1007/s00464-022-09239-1. Epub 2022 Apr 21.
BACKGROUND
This study aimed to clarify the features of superficial non-ampullary duodenal epithelial tumors (SNADETs) on magnifying endoscopy with narrow-band imaging (M-NBI) and magnifying endoscopy with acetic acid and narrow-band imaging (M-AANBI), and evaluate the efficacy of M-NBI/M-AANBI to distinguish high-grade adenomas or adenocarcinomas (HGA/AC) from low-grade adenomas (LGA).
METHODS
Clinicopathological data on 62 SNADETs in 58 patients who underwent preoperative M-NBI/M-AANBI and endoscopic resection were retrospectively reviewed. The pathological results were classified into two categories, LGA and HGA/AC. We evaluated microvascular patterns (MVPs) and microsurface patterns (MSPs) observed by M-NBI and MSPs observed by M-AANBI for characterizing LGA and HGA/AC. The kappa value was calculated to assess the interobserver and intraobserver agreements of evaluation of M-AANBI images.
RESULTS
Pathologically, 38 lesions (61.3%) were LGA and 24 lesions (38.7%) were HGA/AC. HGA/AC tended to have irregular MVP and/or MSP on M-NBI. M-NBI diagnostic performance to distinguish HGA/AC from LGA showed 62.5% sensitivity, 68.4% specificity, and 66.1% accuracy. SNADETs had irregular MSP on M-AANBI. Three irregularity grades (iG) of MSP were observed by M-AANBI as follows: iG1, mild; iG2, moderate; iG3, significant. HGA/AC lesions had a significantly higher rate of iG3 than LGA lesions (p < 0.001). The iG2 was associated with HGA/AC in elevated lesions and LGA in depressed lesions. The diagnostic performance of M-AANBI was as follows: 95.8% sensitivity, 97.4% specificity, and 96.8% accuracy. The diagnostic accuracy of M-AANBI was significantly higher than that of M-NBI (p < 0.001). The kappa value for interobserver agreement on the diagnosis and irregularity grading of M-AANBI images was 0.742 and 0.719, respectively. These data indicate substantial interobserver agreement. Based on the above-mentioned results, we developed a M-AANBI diagnostic algorithm for SNADETs.
CONCLUSION
The diagnostic algorithm for SNADETs using M-AANBI may be useful for differentiating between LGA and HGA/AC.
背景
本研究旨在阐明窄带成像放大内镜（M-NBI）及醋酸联合窄带成像放大内镜（M-AANBI）下浅表非壶腹十二指肠上皮肿瘤（SNADETs）的特征，并评估M-NBI/M-AANBI区分高级别腺瘤或腺癌（HGA/AC）与低级别腺瘤（LGA）的效能。
方法
回顾性分析58例接受术前M-NBI/M-AANBI及内镜切除的患者中62个SNADETs的临床病理资料。病理结果分为LGA和HGA/AC两类。我们评估了通过M-NBI观察到的微血管形态（MVPs）和微表面形态（MSPs）以及通过M-AANBI观察到的MSPs，以鉴别LGA和HGA/AC。计算kappa值以评估M-AANBI图像评估的观察者间及观察者内一致性。
结果
病理上，38个病变（61.3%）为LGA，24个病变（38.7%）为HGA/AC。HGA/AC在M-NBI上往往具有不规则的MVP和/或MSP。M-NBI区分HGA/AC与LGA的诊断性能显示敏感性为62.5%，特异性为68.4%，准确性为66.1%。SNADETs在M-AANBI上具有不规则的MSP。M-AANBI观察到MSP的三种不规则等级（iG）如下：iG1，轻度；iG2，中度；iG3，重度。HGA/AC病变的iG3发生率显著高于LGA病变（p<0.001）。iG2在隆起性病变中与HGA/AC相关，在凹陷性病变中与LGA相关。M-AANBI的诊断性能如下：敏感性为95.8%，特异性为97.4%，准确性为96.8%。M-AANBI的诊断准确性显著高于M-NBI（p<0.001）。M-AANBI图像诊断及不规则分级的观察者间一致性kappa值分别为0.742和0.719。这些数据表明观察者间具有较高的一致性。基于上述结果，我们制定了SNADETs的M-AANBI诊断算法。
结论
使用M-AANBI的SNADETs诊断算法可能有助于区分LGA和HGA/AC。
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