Simplified classification of capillary pattern in Barrett esophagus using magnifying endoscopy with narrow band imaging: implications for malignant potential and interobserver agreement.
Simplified classification of capillary pattern in Barrett esophagus using magnifying endoscopy with narrow band imaging: implications for malignant potential and interobserver agreement.
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DOI：
10.1097/md.0000000000000405
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发表时间：
2015-01
期刊：
影响因子：
1.6
通讯作者：
Kinoshita Y
中科院分区：
文献类型：
--
作者：
Uno G;Ishimura N;Tada Y;Tamagawa Y;Yuki T;Matsushita T;Ishihara S;Amano Y;Maruyama R;Kinoshita Y
由于其复杂性，使用窄带成像放大内窥镜 (ME-NBI) 对 Barrett 食管 (BE) 进行分类并未广泛应用于临床。使用 ME-NBI 建立新的简化可用分类。我们在单一转诊中心进行了一项横断面研究。连续 108 名 BE 患者使用 ME-NBI 和结晶紫 (CV) 色素内窥镜检查以及组织学结果入组。 ME-NBI 观察到的 BE 区域根据毛细血管模式 (CP) 分为 I 型或 II 型，并根据 CV 色素内镜检查的粘膜凹坑模式分为闭合型或开放型；然后，获得活检样本。我们评估了 CP 与凹陷模式之间的关系、具有恶性潜能的因子的表达、微血管密度的百分比以及观察者间的一致性。对 91 名患者的 130 个病变进行了分析。 II 型 CP 比 I 型具有更多的开放型小凹图案区域和显着更高的微血管密度。 II 型 CP 中存在不典型增生、特化肠化生、COX-2、CDX2 和 CD34 表达以及 PCNA 指数显着较高，而多变量分析显示 II 型是存在不典型增生 (OR 11.14)、CD34 表达 (OR) 的最佳预测因子。 3.60）和 PCNA（或 3.29）。观察者间对此分类的一致性非常高 (κ = 0.66)。提出了一种基于 ME-NBI 观察的简化 CP 分类。我们的结果表明，该分类可能有助于监测具有高度恶性潜力的 BE。
The classification of Barrett esophagus (BE) using magnifying endoscopy with narrow band imaging (ME-NBI) is not widely used in clinical settings because of its complexity. To establish a new simplified available classification using ME-NBI. We conducted a cross-sectional study in a single-referral center. One hundred eight consecutive patients with BE using ME-NBI and crystal violet (CV) chromoendoscopy, and histological findings were enrolled. BE areas observed by ME-NBI were classified as type I or II on the basis of capillary pattern (CP), and as closed or open type on the basis of a mucosal pit pattern using CV chromoendoscopy; then, biopsy samples were obtained. We evaluated the relation between CP and pit pattern, expression of the factors with malignant potential, percentage of microvascular density, and interobserver agreement. One hundred thirty lesions from 91 patients were analyzed. Type II CP had more open type pit pattern areas and significantly greater microvascular density than type I. The presence of dysplasia, specialized intestinal metaplasia, expressions of COX-2, CDX2, and CD34, and PCNA index were significantly higher in type II, whereas the multivariate analysis showed that type II was the best predictor for the presence of dysplasia (OR 11.14), CD34 expression (OR 3.60), and PCNA (OR 3.29). Interobserver agreement for this classification was substantial (κ = 0.66). A simplified CP classification based on observation with ME-NBI is presented. Our results indicate that the classification may be useful for surveillance of BE with high malignant potential.