Liu Kai, Bai Jiawei, Gao Li, Zhao Xin, Dong Xin, Chen Hui, Dong Jiaqiang, Niu Min, Han Ying, Liu Zhiguo
Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
School of Medicine, Yan'an University, Yan'an, China.
Surg Endosc. 2024 Jan;38(1):148-157. doi: 10.1007/s00464-023-10496-x. Epub 2023 Nov 9.
The pink-color sign (PCS) has been widely used for diagnosing esophageal squamous cell carcinoma (ESCC) during Lugol's iodine chromoendoscopy. However, the identification of the PCS only relies on the subjective assessments made by the endoscopist, which could lead to bias and disagreement. Previous research has indicated that the V' variable can, as an objective index, define the PCS in the LU'V' color space. We aimed to validate the diagnostic performance of the PCS defined by the V' variable alone and attempt to improve the diagnostic performance by combining the V' and U' variables.
We re-examined 231 subjects with Lugol's unstained lesions (LULs) from a previously reported prospective trial. The diagnostic performance of the method using V' variable alone (V' alone method), the combination method using V' and U' variables (V' + U' method), and the endoscopists were calculated and compared.
A total of 236 LULs were included, among which 46 were histologically confirmed to be cancerous lesions. The sensitivity, specificity, and accuracy of the V' alone method were 73.91% (95% CI 58.87-85.73%), 79.47% (95% CI 73.03-84.98%), and 78.39% (95% CI 72.59-83.47%) in the external validation cohort, respectively. It is inferior to endoscopists in terms of specificity and accuracy. The V' + U' method demonstrated a diagnostic performance comparable to the experienced endoscopists, with sensitivity, specificity, and accuracy of 76.74% (95% CI 61.37-88.25%), 88.64% (95% CI 83.00-92.92%), and 86.30% (95% CI 81.03-90.56%), respectively.
The V' alone method exhibited lower specificity and accuracy than the experienced endoscopist and the V' + U' method. However, the modified V' + U' method demonstrated a diagnostic performance comparable to experienced endoscopists. Utilizing the objective index of the PCS could provide valuable support in clinical decision-making.
在卢戈氏碘染色内镜检查中，粉红色征（PCS）已被广泛用于诊断食管鳞状细胞癌（ESCC）。然而，PCS的识别仅依赖于内镜医师的主观评估，这可能导致偏差和分歧。先前的研究表明，V'变量可作为一个客观指标，在LU'V'颜色空间中定义PCS。我们旨在验证仅由V'变量定义的PCS的诊断性能，并尝试通过结合V'和U'变量来提高诊断性能。
我们重新检查了来自先前报道的前瞻性试验的231例有卢戈氏未染色病变（LULs）的受试者。计算并比较了仅使用V'变量的方法（仅V'方法）、使用V'和U'变量的联合方法（V'+U'方法）以及内镜医师的诊断性能。
共纳入236个LULs，其中46个经组织学证实为癌性病变。在外部验证队列中，仅V'方法的敏感性、特异性和准确性分别为73.91%（95%CI 58.87-85.73%）、79.47%（95%CI 73.03-84.98%）和78.39%（95%CI 72.59-83.47%）。在特异性和准确性方面，它不如内镜医师。V'+U'方法表现出与经验丰富的内镜医师相当的诊断性能，敏感性、特异性和准确性分别为76.74%（95%CI 61.37-88.25%）、88.64%（95%CI 83.00-92.92%）和86.30%（95%CI 81.03-90.56%）。
仅V'方法的特异性和准确性低于经验丰富的内镜医师和V'+U'方法。然而，改良的V'+U'方法表现出与经验丰富的内镜医师相当的诊断性能。利用PCS的客观指标可为临床决策提供有价值的支持。
