Pham Nguyen Binh, Vu Khanh Truong, Nguyen Nam Hoai, Doan Ha Thi-Ngoc, Tran Thanh Trung
Gastroenterology & Hepatology Center, Bach Mai Hospital, Hanoi, Vietnam.
Ha Noi Medical University, Hanoi, Vietnam.
Gastroenterol Res Pract. 2022 Jul 13;2022:6402904. doi: 10.1155/2022/6402904. eCollection 2022.
Virtual magnifying chromoendoscopy with flexible spectral imaging color enhancement (FICE), image-enhanced endoscopy techniques, and dye-staining magnifying chromoendoscopy (with Indigo carmine and Crystal violet) have contributed to better visualization of the pit pattern and vascular structure of colorectal polyp. Therefore, magnifying chromoendoscopy is capable of predicting the histopathological results of colorectal polyp without biopsy and remains their diagnostic values over time, especially in scare-setting resources. This study compared the images of magnifying chromoendoscopy between FICE, Indigo carmine, and Crystal violet and then assessed their diagnostic values based on colorectal polyps' histopathology as a gold standard.
A total of 332 polyps of 266 patients were endoscopically evaluated from June 2016 to September 2019. After identified by white light endoscopy, polyps continued to be evaluated by virtual magnifying chromoendoscopy (×50-150 times) with FICE. The capillary-vessel pattern was divided into 5 subtypes according to the number, morphology, and distribution of the fine blood vessels according to Teixeira classification. Next, they were stained with Indigo carmine 0.2% and then Crystal violet 0.05% and were classified according to Kudo's pit pattern classification. Finally, polyps were resected by endoscopy or surgery and biopsy and compared with histopathological results of either neoplastic or nonplastic polyp.
The number of neoplastic polyps was 278/332 with 231 adenoma polyps and 47 carcinoma polyps. Magnifying chromoendoscopy has high sensitivity and accuracy when compared with the histopathological results of colorectal polyps. The sensitivity, specificity, and accuracy of magnifying chromoendoscopy with Crystal violet are 97.2%, 72.2%, and 93.0%; with Indigo carmine are 96.0%, 72.2%, and 92.1%; and with FICE are 92.1%, 68.5%, and 88.3%.
Among the three methods, Crystal violet has the highest sensitivity and accuracy in predicting histopathological results of colorectal polyps. FICE has shown its diagnostic value with reliable sensitivity and accuracy and should still be a reasonable endoscopic choice for physicians in scare-setting resources regardless its moderate specificity. Physicians should base on their facility and capability to determine an appropriate endoscopy technique.
采用灵活光谱成像色彩增强技术（FICE）的虚拟放大染色内镜检查、图像增强内镜技术以及染料染色放大染色内镜检查（使用靛胭脂和结晶紫）有助于更好地观察大肠息肉的腺管开口形态和血管结构。因此，放大染色内镜检查能够在不进行活检的情况下预测大肠息肉的组织病理学结果，并且随着时间推移仍具有诊断价值，尤其是在资源匮乏的环境中。本研究比较了FICE、靛胭脂和结晶紫三种放大染色内镜检查的图像，然后以大肠息肉的组织病理学结果作为金标准评估它们的诊断价值。
2016年6月至2019年9月，对266例患者的332枚息肉进行了内镜评估。经白光内镜检查发现息肉后，继续采用FICE进行虚拟放大染色内镜检查（放大50 - 150倍）。根据Teixeira分类法，依据微血管的数量、形态和分布将毛细血管形态分为5种亚型。接下来，先用0.2%的靛胭脂染色，然后用0.05%的结晶紫染色，并根据工藤腺管开口分型进行分类。最后，通过内镜或手术切除息肉并进行活检，与肿瘤性或非肿瘤性息肉的组织病理学结果进行比较。
肿瘤性息肉有278/332例，其中腺瘤性息肉231例，癌性息肉47例。与大肠息肉的组织病理学结果相比，放大染色内镜检查具有较高的敏感性和准确性。结晶紫放大染色内镜检查的敏感性、特异性和准确性分别为97.2%、72.2%和93.0%；靛胭脂放大染色内镜检查的敏感性、特异性和准确性分别为96.0%、72.2%和92.1%；FICE放大染色内镜检查的敏感性、特异性和准确性分别为92.1%、68.5%和88.3%。
在这三种方法中，结晶紫在预测大肠息肉组织病理学结果方面具有最高的敏感性和准确性。FICE已显示出其可靠敏感性和准确性的诊断价值，尽管其特异性一般，但对于资源匮乏地区的医生而言，仍应是一种合理的内镜检查选择。医生应根据自身设备和能力来确定合适的内镜检查技术。
