Diagnostic accuracy of magnification endoscopy with acetic acid enhancement and narrow-band imaging in gastric mucosal neoplasms
Diagnostic accuracy of magnification endoscopy with acetic acid enhancement and narrow-band imaging in gastric mucosal neoplasms
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DOI：
10.1055/s-0034-1392542
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发表时间：
2016-01-01
期刊：
影响因子：
9.3
通讯作者：
Kinoshita, Yoshikazu
中科院分区：
文献类型：
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作者：
Shibagaki, Kotaro;Amano, Yuji;Kinoshita, Yoshikazu
背景和研究目的：窄带成像放大内窥镜（NBIME）和醋酸增强NBIME（A-NBIME）分别可视化胃粘膜表面的毛细血管和微观结构模式。本研究旨在比较白光内窥镜 (WLE)、NBIME 和 A-NBIME 在不同组织学类型的胃粘膜肿瘤中的诊断准确性和观察者间一致性。 患者和方法：使用 WLE、NBIME 和 A-NBIME 连续拍摄胃肿瘤（n = 220；49 例腺瘤、144 例分化腺癌和 27 例未分化腺癌）。 A-NBIME。根据先前报道的分类，使用WLE的宏观模式、使用NBIME的毛细血管模式和使用A-NBIME的微观结构模式分别分为M1/M2/M3型、C1/C2/C3/C4型和S1/S2/S3型，作为腺瘤、分化腺癌和未分化腺癌（C4型，由于毛细血管不可见而无法评估）的指标。内窥镜图像由三名专家和三名非专家独立审查。比较了各模式之间的诊断准确性和观察者间诊断一致性。结果：WLE、NBIME 和 A-NBIME 诊断的 Kappa 值（95% 置信区间 [CI]）对于专家为 0.36 (0.33-0.39)、0.58 (0.54-0.61) 和 0.62 (0.55-0.68)，对于专家为 0.31对于非专家来说，为 (0.29-0.33)、0.36 (0.34-0.38) 和 0.52 (0.48-0.56)，无论熟练程度如何，都显示出 A-NBIME 诊断的良好再现性。所有专家和非专家对 A-NBIME 组织学类型的诊断在统计学上都比 WLE 和 NBIME 更准确（P < 0.05）。总体而言，WLE 的“专家一致”诊断准确度 (95%CI) 为 75.5% (70.0-81.0)，NBIME 为 74.1% (67.6-80.6)，A-NBIME 为 90.5% (86.7-94.1) (P < 0.05)。 WLE和NBIME不足以预测腺瘤和未分化腺癌的诊断。结论：A-NBIME对胃粘膜肿瘤的诊断准确性显着高于WLE和NBIME，而WLE和NBIME的准确性较低。
Background and study aims: Magnification endoscopy with narrow-band imaging (NBIME) and NBIME with acetic acid enhancement (A-NBIME) visualize the capillary and microstructure patterns of the gastric mucosal surface, respectively. This study aimed to compare the diagnostic accuracy and interobserver agreement for white-light endoscopy (WLE), NBIME, and A-NBIME in the different histologic types of gastric mucosal neoplasm.Patients and methods: Consecutive gastric neoplasms (n = 220; 49 adenomas, 144 differentiated adenocarcinomas, and 27 undifferentiated adenocarcinomas) were photographed with WLE, NBIME, and A-NBIME. Macroscopic patterns using WLE, capillary patterns using NBIME, and microstructure patterns using A-NBIME were respectively classified into type M1/M2/M3, type C1/C2/C3/C4, and type S1/S2/S3, as the indicators of adenoma, differentiated adenocarcinoma, and undifferentiated adenocarcinoma (Type C4, unevaluable because of capillary invisibility), according to the previously reported classifications. Endoscopic images were independently reviewed by three experts and three non-experts. Diagnostic accuracy and interobserver diagnostic agreement were compared among the modalities.Results: Kappa values (95% confidence interval [CI]) for WLE, NBIME, and A-NBIME diagnosis were 0.36 (0.33-0.39), 0.58 (0.54-0.61), and 0.62 (0.55-0.68) for experts and 0.31 (0.29-0.33), 0.36 (0.34-0.38), and 0.52 (0.48-0.56) for non-experts, showing good reproducibility of A-NBIME diagnosis regardless of proficiency. All experts and non-experts diagnosed the histologic types statistically more accurately with A-NBIME than with WLE and NBIME (P < 0.05). Overall the "experts-agreed" diagnostic accuracy (95%CI) was 75.5% (70.0-81.0) for WLE vs. 74.1% (67.6-80.6) for NBIME vs. 90.5% (86.7-94.1) for A-NBIME (P < 0.05). WLE and NBIME were insufficient to predict the diagnosis of adenomas and undifferentiated adenocarcinomas.Conclusion: A-NBIME showed statistically significantly higher diagnostic accuracy for gastric mucosal neoplasms, with good reproducibility, compared with WLE and NBIME, which provided similar lower accuracy.