Diagnostic yield of the Japan NBI Expert Team (JNET) classification for endoscopic diagnosis of superficial colorectal neoplasms in a large-scale clinical practice database
Diagnostic yield of the Japan NBI Expert Team (JNET) classification for endoscopic diagnosis of superficial colorectal neoplasms in a large-scale clinical practice database
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DOI：
10.1177/2050640619845987
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发表时间：
2019-08-01
影响因子：
6
通讯作者：
Saito, Yutaka
中科院分区：
文献类型：
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作者：
Kobayashi, Shunsuke;Yamada, Masayoshi;Saito, Yutaka
背景：结肠镜检查期间放大窄带成像（NBI）是结直肠病变鉴别和深度诊断的可靠方法。本研究使用大规模临床实践数据库，在临床环境中检查了基于日本NBI专家小组（JNET）分类的放大NBI的诊断率。类型1、2A、2B和3分别对应于增生性息肉/无柄锯齿状息肉、低度粘膜内瘤变、高度粘膜内瘤变/浅粘膜下浸润癌和深粘膜下浸润癌的组织病理学分类。方法：回顾性分析1558例经结肠镜切除的结直肠浅表病变的结肠镜报告和病理资料。排除156个病灶后，对其余1402个结直肠病灶的JNET分类进行了分析。诊断率进行了分析，也比较了专家内镜和非专家内镜。结果1型的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为75%、96%、74%、96%和93%，2A型的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为91%、70%、92%、67%和87%，2B型的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为42%、95%、26%、98%和93%; 3型分别为35%、100%、93%、98%和98%。非专家和专家内镜医师对1、2B和3型的特异性、NPV和准确性均>90%，对2A型的敏感性和PPV均>90%。2B型的敏感性较低，为42%，因为它包括各种组织学特征。结论：JNET分类证明在临床环境中对专家和非专家内镜医师都是有用的，正如最初的JNET定义所预期的那样，但2B型需要使用小凹模式诊断进行进一步研究。
Background:Magnifying Narrow Band Imaging (NBI) during colonoscopy is a reliable method for differential and depth diagnoses of colorectal lesions. This study examined the diagnostic yield of magnifying NBI based on the Japan NBI Expert Team (JNET) classification in a clinical setting using a large-scale clinical practice database. Types 1, 2A, 2B and 3 correspond to the histopathological classifications of hyperplastic polyp/sessile-serrated polyp, low-grade intramucosal neoplasia, high-grade intramucosal neoplasia/shallow submucosal invasive cancer, and deep submucosal invasive cancer, respectively. Methods:The prospective records of colonoscopy reports and pathological data of 1558 consecutive superficial colorectal lesions removed by colonoscopy were retrospectively analysed. After excluding 156 lesions, the documented JNET classifications of the remaining 1402 colorectal lesions were analysed. Diagnostic yield was analysed and also compared between expert endoscopists and nonexpert endoscopists. Results The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were respectively 75%, 96%, 74%, 96% and 93% for type 1; 91%, 70%, 92%, 67% and 87% for type 2A; 42%, 95%, 26%, 98% and 93% for type 2B; and 35%, 100%, 93%, 98% and 98% for type 3. Nonexpert and expert endoscopists alike had specificity, NPV and accuracy >90% for types 1, 2B and 3, and a sensitivity and PPV >90% for type 2A. Type 2B had a low sensitivity of 42% because it included various histological features. Conclusions:The JNET classification proved useful in a clinical setting both for expert and nonexpert endoscopists, as was expected from the original JNET definition, but type 2B requires further investigation using pit pattern diagnosis.