Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan.
Department of Pathology, Pathology and Cytology Laboratory Japan, Tokyo 166-0003, Japan.
World J Gastroenterol. 2022 Jun 28;28(24):2748-2757. doi: 10.3748/wjg.v28.i24.2748.
Accurate diagnosis of colorectal premalignant polyps, including adenomas, is vital in clinical practice.
To investigate the diagnostic yields of novel findings of brown slits for adenomas.
Patients who underwent colonoscopy at the Toyoshima Endoscopy Clinic were enrolled. Polyps sized ≥ 5 mm suspected of adenomas or clinically significant serrated polyps were included in the study. We defined the surface structures of colorectal polyps, which were brown curves inside and along the tubular glands identified using a combination of a new X1 system (Olympus Corporation) and a conventional magnifying colonoscope with non-staining narrow band imaging (NBI), as brown slits. The brown slits corresponded to slit-like lumens on endocytoscopy and histological crypt openings of an adenoma. We evaluated the diagnostic performance of brown slits for adenoma.
A total of 108 Lesions from 62 patients were eligible. The average age was 60.4 years and 41.9% were male. The mean polyp size was 7.45 ± 2.83 mm. Fifty-seven lesions were positive for brown slits. Histopathological diagnosis comprised 59 low-grade tubular adenomas, 16 sessile serrated lesions, and 33 hyperplastic polyps. Among 59 adenomas, 56 (94.9%) were positive for brown slits. Among 16 sessile serrated lesions, 0 (0%) was positive for brown slits. Among 33 hyperplastic polyps, 1 (3.0%) was positive for brown slits. The sensitivity, specificity, and accuracy of brown slits for adenoma were 94.9%, 98.0%, and 96.3%, respectively. The positive predictive value and negative predictive value of brown slits for adenoma were also excellent for 98.2%, and 94.1%, respectively.
Brown slits on conventional magnifying endoscopy with non-staining NBI using the X1 system were useful for diagnosing colorectal adenoma. The new endoscopy system could be examined using new standards.
准确诊断结直肠前体腺瘤性息肉，包括腺瘤，在临床实践中至关重要。
探讨新型棕色裂隙对腺瘤的诊断价值。
纳入在豊岛内镜诊所接受结肠镜检查的患者。纳入研究的息肉大小≥5mm，疑诊腺瘤或临床上显著锯齿状息肉。我们定义结直肠息肉的表面结构，即使用新型 X1 系统（奥林巴斯公司）和带非染色窄带成像（NBI）的常规放大结肠镜结合识别管状腺体内部和沿管状腺体的棕色曲线，将其定义为棕色裂隙。棕色裂隙对应于内镜下细胞学检查的裂隙状管腔和腺瘤组织学隐窝开口。我们评估了棕色裂隙对腺瘤的诊断性能。
共有 62 名患者的 108 个病灶符合纳入标准。患者平均年龄为 60.4 岁，41.9%为男性。平均息肉大小为 7.45±2.83mm。57 个病灶呈阳性的棕色裂隙。组织病理学诊断包括 59 个低级别管状腺瘤、16 个无蒂锯齿状病变和 33 个增生性息肉。在 59 个腺瘤中，56 个（94.9%）呈阳性的棕色裂隙。在 16 个无蒂锯齿状病变中，没有（0%）呈阳性的棕色裂隙。在 33 个增生性息肉中，有 1 个（3.0%）呈阳性的棕色裂隙。棕色裂隙对腺瘤的敏感性、特异性和准确性分别为 94.9%、98.0%和 96.3%。棕色裂隙对腺瘤的阳性预测值和阴性预测值也分别为 98.2%和 94.1%。
新型 X1 系统结合非染色 NBI 的常规放大内镜上的棕色裂隙有助于诊断结直肠腺瘤。新的内镜系统可以使用新标准进行检查。
