醋酸联合窄带成像放大内镜在结直肠小息肉诊断中的价值

Diagnostic value of acetic acid with narrow-band imaging and magnifying endoscopy for small colorectal polyp

摘要:

目的 探讨醋酸联合窄带成像放大内镜（NBI-ME）在结直肠小息肉诊断中的价值。 方法 对行内镜治疗的122例261个肠息肉依次采用放大内镜（ME）、NBI-ME和醋酸联合NBI-ME模式观察病灶，保留图像。分别由3位有放大内镜诊断经验的内镜医师（专家）及3位无放大内镜诊断经验的内镜医师（非专家）独立观察图像，图像评估依据工藤腺管开口形态分型诊断标准。以组织病理诊断为金标准，评价不同放大内镜模式对结直肠小息肉诊断的准确性，并对各种放大模式下图像的清晰度及观察者间的一致性进行对比分析。 结果 专家组ME、NBI-ME、醋酸联合NBI-ME模式诊断结直肠肿瘤性小息肉的准确率分别为65.5％（171／261）、90.0％（235／261）、94.6％（247／261），非专家组分别为57.1％（149／261）、83.1％（217／261）、89.3％（233／261）。专家组、非专家组醋酸联合NBI-ME模式诊断结直肠肿瘤性小息肉的准确率明显高于NBI-ME（P均＜0.05）和ME模式（P均＜0.001）。专家组、非专家组醋酸联合NBI-ME模式清晰度评分均明显大于NBI-ME、ME模式（P均＜0.001）。观察者间一致性评价显示，专家组ME、NBI-ME及醋酸联合NBI-ME模式诊断结直肠肿瘤性小息肉的Kappa值（95％CI）分别为0.578 （0.508～0.648）、0.669 （0.599～0.739）、0.940 （0.870～1.010），非专家组分别为0.476 （0.406～0.546）、 0.534 （0.464～0.604）、 0.830 （0.760～0.900）；醋酸联合NBI-ME模式一致性好。 结论 醋酸联合NBI-ME对结直肠小息肉性质的诊断准确性和可重复性较高。

Abstract:

Objective To evaluate the clinical value of acetic acid with narrow-band imaging （NBI） and magnifying endoscopy （ME） on diagnosis of small colorectal polyps. Methods In this prospective study， 261 small colorectal polyps from 122 patients were observed by ME， NBI-ME， and acetic acid with NBI-ME， and then received endoscopic treatment. Endoscopic images were stored electronically and randomly allocated to 3 experts and 3 non-experts for diagnosis using Kudo pit pattern. The postoperative pathologic results acted as gold standard to evaluate the diagnostic accuracy of different endoscopic modes for small colorectal polyps. The image definition and interobserver agreement were compared among different endoscopic modes. Results The diagnostic accuracy of ME， NBI-ME， and acetic acid with NBI-ME for small colorectal polyps was 65.5％ （171／261）， 90.0％ （235／261）， and 94.6％ （247／261）， respectively， in the experts group， and 57.1％ （149／261）， 83.1％ （217／261）， and 89.3％ （233／261）， respectively， in the non-experts group. All experts and non-experts diagnosed small colorectal polyps more accurately by acetic acid with NBI-ME than by NBI-ME （all P＜0.05） and ME （all P＜0.001）. The image definition scores of acetic acid with NBI-ME in the experts group and non-experts group were significantly higher than those of NBI-ME and ME （all P＜0.001）. The results of interobserver agreement showed that Kappa values （95％CI） of ME， NBI-ME， and acetic acid with NBI-ME diagnosis were 0.578 （0.508-0.648）， 0.669 （0.599-0.739）， and 0.940 （0.870-1.010）， respectively， for experts and 0.476 （0.406-0.546）， 0.534 （0.464-0.604）， and 0.830 （0.760-0.900）， respectively， for non-experts. Acetic acid with NBI-ME showed good interobserver agreement. Conclusion Acetic acid with NBI-ME has a higher diagnostic accuracy and good reproducibility for colorectal small polyps compared with ME and NBI-ME.