使用放大窄带成像技术对浅表非壶腹性十二指肠上皮肿瘤的上皮亚型进行内镜诊断。

Endoscopic Diagnosis of Epithelial Subtypes of Superficial Non-Ampullary Duodenal Epithelial Tumors using Magnifying Narrow-Band Imaging.

机构信息

Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

出版信息

Dig Dis. 2024;42(5):399-406. doi: 10.1159/000539308. Epub 2024 May 15.

DOI:10.1159/000539308

PMID:38749404

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11457973/

Abstract

INTRODUCTION

Superficial non-ampullary duodenal epithelial tumors (SNADETs) include low-grade adenoma (LGA) and high-grade adenoma or carcinoma (HGA/Ca) and are classified into two different epithelial subtypes, gastric-type (G-type) and intestinal-type (I-type). We attempted to distinguish them by endoscopic characteristics including magnifying endoscopy with narrow-band imaging (M-NBI).

METHODS

Various endoscopic and M-NBI findings of 286 SNADETs were retrospectively reviewed and compared between G- and I-types and histological grades. M-NBI findings were divided into four patterns based on the following vascular patterns; absent, network, intrastructural vascular (ISV), and unclassified. Lesions displaying a single pattern were classified as mono-pattern and those displaying multiple patterns as mixed-pattern. Lesions showing CDX2 positivity were categorized as I-types and those showing MUC5AC or MUC6 positivity were categorized as G-types based on immunohistochemistry.

RESULTS

Among 286 lesions, 23 (8%) were G-type and 243 (85%) were I-type. More G-type lesions were located oral to papilla (91.3 vs. 45.6%, p < 0.001), and had protruding morphology compared to those of I-types (65.2 vs. 14.4%, p < 0.001). The major M-NBI pattern was ISV in G-type (78.2 vs. 26.3%, p < 0.001), and absent for I-type (0 vs. 34.5%, p = 0.003). Three endoscopic characteristics; location oral to papilla, protruding morphology, and major M-NBI pattern (ISV) were independent predictors for G-type. Mixed-pattern was more common in HGA/Ca than LGA for I-type (77.0 vs. 58.8%, p = 0.01); however, there was no difference for those in G-type.

CONCLUSION

Endoscopic findings including M-NBI are useful to differentiate epithelial subtypes.

摘要

简介

非壶腹浅表性十二指肠上皮肿瘤（SNADETs）包括低级别腺瘤（LGA）和高级别腺瘤或癌（HGA/Ca），并分为两种不同的上皮亚型，胃型（G 型）和肠型（I 型）。我们试图通过包括窄带成像放大内镜（M-NBI）在内的内镜特征来区分它们。

方法

回顾性分析了 286 例 SNADETs 的各种内镜和 M-NBI 表现，并比较了 G 型和 I 型以及组织学分级之间的差异。根据以下血管模式，将 M-NBI 表现分为四种类型：缺失、网络、结构内血管（ISV）和未分类。表现为单一模式的病变被归类为单模式，表现为多种模式的病变被归类为混合模式。根据免疫组织化学，CDX2 阳性的病变归类为 I 型，MUC5AC 或 MUC6 阳性的病变归类为 G 型。

结果

在 286 个病变中，23 个（8%）为 G 型，243 个（85%）为 I 型。与 I 型相比，更多的 G 型病变位于乳头口（91.3%比 45.6%，p < 0.001），且具有外突形态（65.2%比 14.4%，p < 0.001）。G 型的主要 M-NBI 模式为 ISV（78.2%比 26.3%，p < 0.001），而 I 型则为缺失（0%比 34.5%，p = 0.003）。位于乳头口、外突形态和主要 M-NBI 模式（ISV）这三个内镜特征是 G 型的独立预测因素。对于 I 型，与 LGA 相比，HGA/Ca 中混合模式更为常见（77.0%比 58.8%，p = 0.01）；然而，对于 G 型，两者之间没有差异。