Department of Gastroenterology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
Department of Gastroenterology and Hepatology, The Air Force Medical Center of PLA, Beijing, China.
J Dig Dis. 2022 May;23(5-6):310-317. doi: 10.1111/1751-2980.13109. Epub 2022 Aug 2.
Linked color imaging (LCI) is a recently developed technique that emphasizes differences in mucosal color. In this study we aimed to develop a LCI classification based on the Narrow-band Imaging International Colorectal Endoscopic Classification for predicting colorectal polyp histology and evaluate the validity and performance of the endoscopists in differentiating hyperplastic polyps from adenomas using the LCI classification.
A workshop involving six international experts from China and Japan with substantial experience with LCI developed the classification. Three experienced and seven less-experienced endoscopists used the LCI images to predict the histology of polyps independently, recording their degrees of confidence in these predictions before and after completing the training test for the LCI classification.
Of the 50 polyps included, 30 (60.0%) were adenomas. Overall diagnostic accuracy before training was 75.4% (95% confidence interval [CI] 71.4%-79.1%), which increased to 85.2% (95% CI 81.8%-88.2%) after training. After training, the experienced and less-experienced endoscopists achieved an overall accuracy of 87.3% and 84.3% for the prediction of polyp histology. Polyp prediction using the color criterion alone had the highest specificity and positive predictive value, whereas the vessel criterion achieved the highest accuracy and negative predictive value among all three individual LCI criteria. After training, both the experienced and less-experienced endoscopists had high degrees of interobserver agreement.
We developed and validated the first LCI classification for endoscopic differentiation of adenomas and hyperplastic polyps. The LCI classification significantly improved the diagnostic accuracy of colorectal polyps.
联合显色成像（LCI）是一种最近开发的技术，强调黏膜颜色的差异。本研究旨在基于窄带成像国际结直肠内镜分类（Narrow-band Imaging International Colorectal Endoscopic Classification）开发一种 LCI 分类，以预测结直肠息肉的组织学，并评估内镜医师使用 LCI 分类区分增生性息肉和腺瘤的有效性和性能。
一个由来自中国和日本的六位具有丰富 LCI 经验的国际专家组成的研讨会制定了该分类。三位经验丰富的内镜医师和七位经验较少的内镜医师使用 LCI 图像独立预测息肉的组织学，在完成 LCI 分类培训测试之前和之后记录他们对这些预测的置信度。
50 个息肉中，30 个（60.0%）为腺瘤。培训前的总体诊断准确性为 75.4%（95%置信区间[CI]71.4%-79.1%），培训后增加至 85.2%（95% CI 81.8%-88.2%）。培训后，经验丰富和经验较少的内镜医师对息肉组织学的总体预测准确率分别为 87.3%和 84.3%。单独使用颜色标准预测息肉具有最高的特异性和阳性预测值，而血管标准在所有三个单独的 LCI 标准中具有最高的准确性和阴性预测值。培训后，经验丰富和经验较少的内镜医师之间具有高度的观察者间一致性。
我们开发并验证了用于结直肠腺瘤和增生性息肉内镜鉴别诊断的首个 LCI 分类。LCI 分类显著提高了结直肠息肉的诊断准确性。
