Suzuki Kenichi, Kudo Shin-Ei, Kudo Toyoki, Misawa Masashi, Mori Yuichi, Ichimasa Katsuro, Maeda Yasuharu, Hayashi Takemasa, Wakamura Kunihiko, Baba Toshiyuki, Ishda Fumio, Hamatani Shigeharu, Inoue Haruhiro, Yokoyama Kazunori, Miyachi Hideyuki
Digestive Disease Center Showa University Northern Yokohama Hospital Kanagawa Japan.
Suzuki Gastrointestinal Clinic Akita Japan.
DEN Open. 2023 May 8;4(1):e238. doi: 10.1002/deo2.238. eCollection 2024 Apr.
A "resect-and-discard" strategy has been proposed for diminutive adenomas in the colorectum. However, this strategy is sometimes difficult to implement because of the lack of confidence in differentiating low-grade adenoma (LGA) from advanced lesions such as high-grade adenoma or carcinoma. To perform real-time precise diagnosis of LGA with high confidence, we assessed whether endocytoscopy (EC) diagnosis, considering normal pit-like structure (NP-sign), an excellent indicator of LGA, could have additional diagnostic potential compared with conventional modalities.
All the neoplastic lesions that were observed by non-magnifying narrow-band imaging (NBI), magnifying NBI (M-NBI), magnifying pit pattern, and EC prior to pathological examination between 2005 and 2018 were retrospectively investigated. The neoplastic lesions were classified into two categories: LGA and other neoplastic lesions. We assessed the differential diagnostic ability of EC with NP-sign between LGA and other neoplastic lesions compared with that of NBI, M-NBI, pit pattern, and conventional EC in terms of sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC).
A total of 1376 lesions from 1097 patients were eligible. The specificity (94.9%), accuracy (91.5%), and area under the receiver operating characteristic curve (0.95) of EC with NP-sign were significantly higher than those of NBI, M-NBI, pit pattern, and conventional EC.
EC diagnosis with NP-sign has significantly higher diagnostic performance for predicting colorectal LGA compared with the conventional modalities and enables stratification of neoplastic lesions for "resect-and-discard" with higher confidence.
对于结直肠微小腺瘤，已提出一种“切除并丢弃”策略。然而，由于难以自信地区分低级别腺瘤（LGA）与高级别腺瘤或癌等进展性病变，该策略有时难以实施。为了对LGA进行高可信度的实时精确诊断，我们评估了考虑正常隐窝样结构（NP征）（LGA的一个优秀指标）的内镜下活检（EC）诊断与传统方法相比是否具有额外的诊断潜力。
回顾性研究2005年至2018年间在病理检查前通过非放大窄带成像（NBI）、放大NBI（M-NBI）、放大隐窝形态和EC观察到的所有肿瘤性病变。肿瘤性病变分为两类：LGA和其他肿瘤性病变。我们从敏感性、特异性、准确性和受试者操作特征曲线下面积（AUC）方面评估了与NBI、M-NBI、隐窝形态和传统EC相比，具有NP征的EC在LGA和其他肿瘤性病变之间的鉴别诊断能力。
共有来自1097例患者的1376个病变符合条件。具有NP征的EC的特异性（94.9%）、准确性（91.5%）和受试者操作特征曲线下面积（0.95）显著高于NBI、M-NBI、隐窝形态和传统EC。
与传统方法相比，具有NP征的EC诊断在预测结直肠LGA方面具有显著更高的诊断性能，并且能够更自信地对肿瘤性病变进行分层以实施“切除并丢弃”策略。
