Indigo carmine-assisted high-magnification chromoscopic colonoscopy for the detection and characterisation of Intraepithelial neoplasia in ulcerative colitis: A prospective evaluation
Indigo carmine-assisted high-magnification chromoscopic colonoscopy for the detection and characterisation of Intraepithelial neoplasia in ulcerative colitis: A prospective evaluation
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DOI：
10.1055/s-2005-921032
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发表时间：
2005-12-01
期刊：
影响因子：
9.3
通讯作者：
Cross, SS
中科院分区：
文献类型：
--
作者：
Hurlstone, DP;Sanders, DS;Cross, SS
背景和研究目的：最近的数据表明，在慢性溃疡性结肠炎患者的监测结肠镜检查中，使用亚甲基蓝的全色镜检查可以提高上皮内肿瘤病变的检出率。这种方法也被证明可以更准确地诊断疾病的程度和炎症活动。尽管采用目前接受的监测活检方案，间隔期癌症已知发生在慢性溃疡性结肠炎患者中。我们假设，与目前的常规结肠镜检查和活检监测相比，单独进行高倍成像的靶向色检可能会增加检测到的上皮内肿瘤病变的总数。患者和方法：对350例长期溃疡性结肠炎（>= 8年）患者采用高倍色镜结肠镜（HMCC）进行监测结肠镜检查。除对异常粘膜区域进行定向活检外，拔管时每隔10cm进行四象限活检。使用改良的Kudo隐窝模式分析进一步评估明确的病变。这些数据与2001年1月至2005年4月期间接受常规结肠镜检查的350名疾病病程和疾病程度匹配的对照患者的数据进行了比较。结果：与对照组相比，放大镜组检测到的上皮内肿瘤病变明显更多（69 vs. 24, P < 0.0001）。在67个病变中观察到上皮内瘤变，其中53个（79%）仅用放大镜检查发现。与对照组相比，色镜检查发现的扁平病变伴上皮内瘤变的数量增加（P < 0.001）。HMCC组12 850例非靶向活检中检出上皮内肿瘤病变20例（0.16%），而HMCC组644例靶向活检中检出上皮内肿瘤病变49例（8%）。在对照组患者的12482例非靶向活检中，18例（0.14%）显示上皮内瘤变。然而，对照组（即没有HMCC成像）的靶向活检上皮内肿瘤病变的发生率仅略微提高了1.6%（6/369）。采用改良的Kudo标准，HMCC鉴别肿瘤和非肿瘤病变的敏感性和特异性分别为93%和88%。HMCC组总手术时间明显长于对照组（P < 0.02）。结论：在慢性溃疡性结肠炎患者的内镜筛查中，放大镜检查提高了上皮内瘤变的检出率。肿瘤性和非肿瘤性粘膜改变可以使用放大技术以较高的整体准确性预测。这些辅助内窥镜技术具有重要的临床意义，并可能导致当前实践指南的变化。
Background and Study Aims: Recent data suggest that panchromoscopy using methylene blue can improve the detection of intraepithelial neoplastic lesions in the context of surveillance colonoscopy for patients with chronic ulcerative colitis. This method has also been shown to provide a more accurate diagnosis of the extent of disease and inflammatory activity. Interval cancers are known to occur in patients with chronic ulcerative colitis despite the adoption of currently accepted surveillance biopsy protocols. We hypothesised that targeted chromoscopy alone, with high-magnification imaging, may increase the total number of intraepithelial neoplastic lesions detected, compared with conventional colonoscopy and biopsy surveillance according to current protocols.Patients and Methods: A total of 350 patients with long-standing ulcerative colitis (>= 8 years) underwent surveillance colonoscopy using high-magnification chromoscopic colonoscopy (HMCC). Quadrantic biopsies at 10-cm intervals were taken on extubation in addition to targeted biopsies of abnormal mucosal areas. Defined lesions were further evaluated using modified Kudo crypt pattern analysis. These data were compared with data from 350 disease duration- and disease extent-matched control patients who had undergone conventional colonoscopic surveillance between January 2001 and April 2005.Results: Significantly more intraepithelial neoplastic lesions were detected in the magnification chromoscopy group compared with controls (69 vs. 24, P < 0.0001). Intraepithelial neoplasia was observed in 67 lesions, of which 53 (79%) were detected using magnification chromoscopy alone. Chromoscopy increased the number of flat lesions with intraepithelial neoplasia detected compared with controls (P < 0.001). Twenty intraepithelial neoplastic lesions were detected from 12 850 non-targeted biopsies in the HMCC group (0.16%), while 49 intraepithelial neoplastic lesions were detected from the 644 targeted biopsies in the HMCC group (8%). From 12482 non-targeted biopsies taken in the control group patients, 18 (0.14%) showed intraepithelial neoplasia. The yield of intraepithelial neoplastic lesions from targeted biopsies in the control group (i.e. without HMCC imaging), however, was only modestly improved at 1.6% (6/369). Using modified Kudo criteria, the sensitivity and specificity for differentiating neoplastic from non-neoplastic lesions using HMCC were 93% and 88% respectively. The total procedure time was significantly longer in the HMCC group compared with controls (P < 0.02).Conclusions: Magnification chromoscopy improves the detection of intraepithelial neoplasia in the endoscopic screening of patients with chronic ulcerative colitis. Neoplastic and non-neoplastic mucosal change can be predicted with a high overall accuracy using magnification techniques. These adjunctive endoscopic techniques have important clinical implications and may lead to changes in current practice guidelines.