Diagnostic Value of Adding Magnifying Chromoendoscopy to Magnifying Narrow-Band Imaging Endoscopy for Colorectal Polyps
Diagnostic Value of Adding Magnifying Chromoendoscopy to Magnifying Narrow-Band Imaging Endoscopy for Colorectal Polyps
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DOI：
10.1016/j.cgh.2023.01.028
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发表时间：
2023-08-23
影响因子：
12.6
通讯作者：
Kato, Naoya
中科院分区：
文献类型：
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作者：
Matsumura, Tomoaki;Ebigbo, Alanna;Kato, Naoya
背景与目的：本研究探讨放大色素内窥镜(MCE)对放大窄带成像内窥镜(M-NBI)在大肠息肉光学诊断中的附加价值。方法：在日本和德国的9家机构进行多中心前瞻性研究。计划切除大肠息肉的患者包括在内。首先用M-NBI进行光学诊断，然后进行MCE检查。这两种诊断都是实时做出的。根据日本NBI专家组的分类，对所有2B型病变和其他病变进行MCE，由内窥镜医师自行决定。结果：从2018年2月至2020年12月，共有1173个结直肠癌病灶，其中654个结直肠癌(5个增生性息肉/无梗锯齿状病变，162个低度不典型增生，403个高度不典型增生，97个T1C，32个>；=T2个结直肠癌)在M-NBI后进行了MCE检查。M-NBI与MCE的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为63.1%、94.2%、61.6%、94.5%和90.2%，而MCE分别为77.4%、93.2%、62.5%、96.5%和91.1%。MCE的敏感性明显高于M-NBI(P=T1b)。结论：在这项多中心前瞻性研究中，我们证实了MCE对M-NBI的附加价值。我们建议对于置信度较低的病变或被诊断为>；=T1b的结直肠癌，建议增加MCE。试验登记号：UMIN000031129。
BACKGROUND & AIMS: This study examined the additional value of magnifying chromoendoscopy (MCE) on magnifying narrow-band imaging endoscopy (M-NBI) in the optical diagnosis of colorectal polyps.METHODS: A multicenter prospective study was conducted at 9 facilities in Japan and Germany. Patients with colorectal polyps scheduled for resection were included. Optical diagnosis was performed by M-NBI first, followed by MCE. Both diagnoses were made in real time. MCE was performed on all type 2B lesions classified according to the Japan NBI Expert Team classification and other lesions at the discretion of endoscopists. The diagnostic accuracy and confidence of M-NBI and MCE for colorectal cancer (CRC) with deep invasion (>= T1b) were compared on the basis of histologic findings after resection.RESULTS: In total, 1173 lesions were included between February 2018 and December 2020, with 654 (5 hyperplastic polyp/sessile serrated lesion, 162 low-grade dysplasia, 403 high-grade dysplasia, 97 T1 CRCs, and 32 >= T2 CRCs) examined using MCE after M-NBI. In the diagnostic accuracy for predicting CRC with deep invasion, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for M-NBI were 63.1%, 94.2%, 61.6%, 94.5%, and 90.2%, respectively, and for MCE they were 77.4%, 93.2%, 62.5%, 96.5%, and 91.1%, respectively. The sensitivity was significantly higher in MCE (P = T1b CRC by M-NBI.CONCLUSIONS: In this multicenter prospective study, we demonstrated the additional value of MCE on M-NBI. We suggest that additional MCE be recommended for lesions with low confidence or the ones diagnosed as >= T1b CRC. Trials registry number: UMIN000031129.