摘要
目的分析窄带成像内镜(NBI)下结直肠腺瘤表面特征,评价NBI在鉴别肿瘤性病变和非肿瘤性病变中的作用。方法选取结直肠息肉患者纳入该研究,将NBI内镜下病变黏膜表面形态分四型,以病变切除后的组织学结果为金标准,比较黏膜表面形态和组织病理学结果的关系。另外,取30张图像进行观察者间一致性评价。结果对入选的156例患者259个病变包括增生性息肉105个,结肠腺瘤154个进行NBI检查,增生性息肉主要表现为Ⅰ型(81/105),低级别上皮内瘤变的腺瘤以Ⅱ型为多(96/120),高级别上皮内瘤变的腺瘤以Ⅲ型和Ⅳ型为著(24/34)。Ⅰ型预测增生性息肉即区分肿瘤性病变和非肿瘤性病变的敏感度、特异度分别为77.1%、90.9%,Ⅱ型微血管形态预测低级别上皮内瘤变的敏感性、特异性分别为80.0%、79.1%,Ⅲ型和Ⅳ型预测高级别上皮内瘤变的敏感性、特异性分别为70.6%、93.3%。观察者间一致性评价结果示kappa值0.784(CI,0.635,0.915),提示评价强度为较好。结论结直肠腺瘤在NBI下有腺管开口形态和微血管形态的显著特征,借此可区分结直肠肿瘤性病变和非肿瘤性病变,为内镜实时诊断及治疗结直肠病变提供了有利工具。
【Objective】To clarify the characteristics of colorectal adenoma by narrow band imaging （NBI） and assess the ability of differentiation colorectal adenoma and hyperplastic polyps.【Methods】Consecutive patients with colorectal polys were recruited in the study.All the lesions were observed under NBI and the surface pattern was categorized into one of the four types.Results of NBI were compared with the histological results.In addition,the interobserver agreement was assessed.【Results】A total of 283 colorectal lesions,105 hyperplastic polyps,154 adenomas which included 120 of low grade intraepithelial neoplasia （LGIN） and 34 of high grade intraepithelial neoplasia （HGIN） were examined by NBI.Most hyperplastic polyps showed type Ⅰ pattern （81/105）.The surface patterns of adenomas with LGIN were mainly type Ⅱ pattern （96/120）.The major vascular patterns of adenomas with HGIN were type Ⅲ and Ⅳ pattern.The type Ⅰ pattern was assumed to diagnose of hyperplastic polyps,which is to differentiate between neoplastic and non-neoplastic lesions,with a sensitivity and specificity of 77.1% and 90.9% respectively.Type Ⅱ patterns were assumed to be indices of adenomas with LGIN,the sensitivity and specificity was 80.0% and 79.1%.Type Ⅲ patterns were assumed to diagnose of adenomas with LGIN,the sensitivity and specificity was 70.6% and 93.3%.The kappa value for the interobserver agreement was 0.784 （CI,0.635,0.915）.【Conclusions】 The characteristics of colorectal adenoma by NBI makes it distinguishing from hyperplastic polyps,which is a promising tool for diagnosing and determining treatment selection.
出处
《中国内镜杂志》
CSCD
北大核心
2010年第11期1121-1124,1128,共5页
China Journal of Endoscopy
基金
首都医学发展科研基金(2009-3117)资助
关键词
窄带成像内镜
结直肠腺瘤
诊断
narrow band imaging
colorectal adenoma
diagnosis
