Narrow-band imaging with dual focus magnification in differentiating colorectal neoplasia
Narrow-band imaging with dual focus magnification in differentiating colorectal neoplasia
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DOI：
10.1111/den.12075
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发表时间：
2013-05-01
影响因子：
5.3
通讯作者：
Uedo, Noriya
中科院分区：
文献类型：
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作者：
Singh, Rajvinder;Jayanna, Mahesh;Uedo, Noriya
背景：大肠息肉的实时光学诊断可以节省大量的时间和成本，并有可能减少息肉切除术相关的并发症。我们前瞻性地评估了一种新的窄带成像(NBI)系统在连续接受结肠镜检查的患者中鉴别大肠息肉的作用。患者和方法所有手术均使用具有双聚焦能力的190系列Exera III NBI原型系统进行。根据改良的Sano‘s分级(低/高)，使用NBI-DF实时预测每个息肉的组织学。然后将NBI-DF诊断结果与最终(盲法)组织病理学结果进行比较。主要终点是当所有息肉被高度可信地诊断时，用改良的Sano‘s分类进行内窥镜预测的准确性。次要终点是息肉切除术后监测微小息肉的时间间隔的准确性(5 Mm)。总共评估了87名患者(53名男性)的164例息肉，平均年龄63岁(范围2886岁)。结果经鼻内窥镜诊断的149例息肉，其中小息肉80例，小息肉31例，10 mm大息肉38例。NBI-DF与最终组织病理学的总体准确率为97%。基于内窥镜预测的息肉切除术后监测间隔的准确率为97%。腺瘤组织学诊断小型直肠乙状结肠息肉的NPV为100%。结论在这项初步的可行性研究中，NBI-DF对大肠息肉的组织学预测具有较高的准确性。此外，两个次级终点都超过了治疗小息肉的ASGE Pivi阈值。
Background Real-time optical diagnosis of colorectal polyps may lead to substantial time and cost savings and could potentially reduce complications associated with polypectomy. We prospectively assessed the utility of a novel narrow-band imaging (NBI) system with dual focus magnification (DF) in differentiating colorectal polyps in consecutive patients undergoing colonoscopy. Patients and Methods All procedures were carried out with a prototype 190 series Exera III NBI system with Dual Focus capability. Histology of each polyp was predicted in real time with NBI-DF based on the modified Sano's classification with a confidence level (low/high). NBI-DF diagnosis was then compared to the final (blinded) histopathology results. Primary endpoint was the accuracy of endoscopic prediction with the modified Sano's classification of all polyps when they were diagnosed with high confidence. Secondary endpoints were the accuracy of post-polypectomy surveillance intervals for diminutive polyps(5mm). A total of 164 polyps in 87 patients (53 males) with a mean age of 63 (range 2886) years were evaluated. Results 149 polyps were diagnosed with high confidence on endoscopic prediction, out of which 80 were diminutive, 31 small (69mm) and 38 large (>10mm). Overall accuracy of NBI-DF compared to final histopathology was 97%. The accuracy for post-polypectomy surveillance interval based on the endoscopic prediction was 97%. The NPV for diminutive rectosigmoid polyps for adenomatous histology was 100%. Conclusion In this preliminary feasibility study, NBI-DF permitted prediction of histology of colorectal polyps with high accuracy. In addition, both of the secondary endpoints exceeded the ASGE PIVI thresholds for the management of diminutive polyps.