Huynh Tien Manh, Le Quang Dinh, Le Nhan Quang, Le Huy Minh, Quach Duc Trong
Department of Internal Medicine University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh City Vietnam.
GI Endoscopy Department University Medical Center Ho Chi Minh City Ho Chi Minh City Vietnam.
JGH Open. 2024 May 10;8(5):e13058. doi: 10.1002/jgh3.13058. eCollection 2024 May.
Small rectosigmoid colorectal polyps (<10 mm) are prevalent, with a low prevalence of advanced neoplastic lesions. The "diagnose-and-leave" strategy, employing narrow band imaging (NBI), is gaining popularity for its safety and cost-effectiveness by reducing polypectomy complications and minimizing histopathology expenses. This study assessed the diagnostic efficacy of NBI with dual focus (DF) magnification for real-time neoplastic prediction of rectosigmoid polyps and explored the feasibility of implementing this strategy in Vietnam.
In a prospective single-center study, 307 rectosigmoid polyps from 245 patients were analyzed using three consecutive endoscopic modes: white light endoscopy (WLE), NBI, and NBI-DF. Endoscopists assessed polyps for size, location, macroscopic shape, optical diagnosis, and confidence levels before histopathological evaluation. High confidence was assigned when the polyp exhibited all features of a single histology type. Predictions were compared with final histopathology results.
Of the total, 237 (77.2%) were diminutive (≤5 mm) polyps, and 18 (5.8%) were advanced neoplastic lesions. WLE + NBI and WLE + NBI + NBI-DF exhibited significantly higher accuracy compared to WLE (88.6% and 90.2% 74.2%, < 0.01). For diminutive polyps, the DF mode significantly increased the rate of high-confidence optical diagnoses (89.1% 94.9%, < 0.001). WLE + NBI + NBI-DF demonstrated high sensitivity (90.1%), specificity (95.5%), and negative predictive value (93.4%) in high-confidence predictions, enabling the implementation of the "diagnose-and-leave" strategy. This approach would have reduced 58.2% of unnecessary polypectomies without missing any advanced neoplastic lesions.
NBI and DF modes provide accurate neoplastic predictions for rectosigmoid polyps. For diminutive polyps, DF magnification improves the confidence level of the optical diagnosis, allowing the safe implementation of the "diagnose-and-leave" strategy.
小的直肠乙状结肠结直肠息肉（<10毫米）很常见，高级别肿瘤性病变的发生率较低。采用窄带成像（NBI）的“诊断并留观”策略因能降低息肉切除并发症并减少组织病理学费用，从而具有安全性和成本效益，正越来越受欢迎。本研究评估了双焦点（DF）放大的NBI对直肠乙状结肠息肉进行实时肿瘤预测的诊断效能，并探讨了在越南实施该策略的可行性。
在一项前瞻性单中心研究中，对来自245例患者的307个直肠乙状结肠息肉使用三种连续的内镜模式进行分析：白光内镜检查（WLE）、NBI和NBI-DF。在内镜医师对息肉进行组织病理学评估之前，评估息肉的大小、位置、宏观形态、光学诊断和置信度。当息肉表现出单一组织学类型的所有特征时，给予高置信度。将预测结果与最终组织病理学结果进行比较。
总共237个（77.2%）为微小（≤5毫米）息肉，18个（5.8%）为高级别肿瘤性病变。与WLE相比，WLE + NBI和WLE + NBI + NBI-DF表现出显著更高的准确率（分别为88.6%和90.2%对74.2%，<0.01）。对于微小息肉，DF模式显著提高了高置信度光学诊断的比例（89.1%对94.9%，<0.001）。WLE + NBI + NBI-DF在高置信度预测中表现出高灵敏度（90.1%）、特异性（95.5%）和阴性预测值（93.4%），从而能够实施“诊断并留观”策略。这种方法可减少58.2%的不必要息肉切除术，且不会遗漏任何高级别肿瘤性病变。
NBI和DF模式可为直肠乙状结肠息肉提供准确的肿瘤预测。对于微小息肉，DF放大提高了光学诊断的置信度，从而允许安全地实施“诊断并留观”策略。
