CAJ | 학술논문

目的分析普通窄带成像(NBI)内镜下结直肠增生性息肉与腺瘤腺管及微血管特征的差异,评价NBI的鉴别诊断价值.方法将普通内镜下诊断结直肠息肉、病理检查证实为增生性息肉或腺瘤者纳入研究并进行NBI内镜检查.将腺管形态参照改良的工藤分型法分为A型和B型.将微血管形态分为3型,无微血管判为Ⅰ型,微血管沿腺管开口排列、粗细均匀判为Ⅱ型,微血管粗细不均、排列紊乱判为Ⅲ型.比较增生性息肉和腺瘤NBI图像中腺管形态和微血管形态特征的差异,同时对无放大NBI图像观察者间的一致性进行评价.结果共87例患者的107个息肉(腺瘤73个、增生性息肉34个)进行普通NBI内镜检查.腺瘤组息肉最大径和表面分叶者比例明显高于增生性息肉组(P值分别=0.0023和0.0047).腺瘤组中B型腺管形态[86.3％(63/73)]及Ⅱ或Ⅲ型微血管形态[82.2％(60/73)]者较多.以B型腺管形态、Ⅱ型或Ⅲ型微血管中任一特征诊断腺瘤的敏感度、特异度、准确率分别为97.3％、82.4％、92.5％.以B型腺管形态联合Ⅱ型或Ⅲ型微血管诊断腺瘤的敏感度、特异度、准确率分别为71.2％、91.2％、77.6％.观察者间一致性评价平均Kappa值为0.761.结论普通NBI内镜下结直肠腺瘤和增生性息肉的微血管特征和腺管特征存在差异,依据以上两方面可在NBI内镜下实时初步鉴别腺瘤和增生性息肉.
목적 분석보통착대성상(NBI)내경하결직장증생성식육여선류선관급미혈관특정적차이,평개NBI적감별진단개치.방법 장보통내경하진단결직장식육、병리검사증실위증생성식육혹선류자납입연구병진행NBI내경검사.장선관형태삼조개량적공등분형법분위A형화B형.장미혈관형태분위3형,무미혈관판위Ⅰ형,미혈관연선관개구배렬、조세균균판위Ⅱ형,미혈관조세불균、배렬문란판위Ⅲ형.비교증생성식육화선류NBI도상중선관형태화미혈관형태특정적차이,동시대무방대NBI도상관찰자간적일치성진행평개.결과 공87례환자적107개식육(선류73개、증생성식육34개)진행보통NBI내경검사.선류조식육최대경화표면분협자비례명현고우증생성식육조(P치분별=0.0023화0.0047).선류조중B형선관형태[86.3％(63/73)]급Ⅱ혹Ⅲ형미혈관형태[82.2％(60/73)]자교다.이B형선관형태、Ⅱ형혹Ⅲ형미혈관중임일특정진단선류적민감도、특이도、준학솔분별위97.3％、82.4％、92.5％.이B형선관형태연합Ⅱ형혹Ⅲ형미혈관진단선류적민감도、특이도、준학솔분별위71.2％、91.2％、77.6％.관찰자간일치성평개평균Kappa치위0.761.결론 보통NBI내경하결직장선류화증생성식육적미혈관특정화선관특정존재차이,의거이상량방면가재NBI내경하실시초보감별선류화증생성식육.
Objective To analyze the differences of morphological and microvascular characteristics between hyperplastic polyps and colorectal adenoma (CA) under narrow band imaging (NBI) without magnification endoscopy,and to evaluate the value of NBI in differential diagnosis.Methods Patients with rectal polyps diagnosed by common endoscopy and pathologically confirmed CA and hyperplastic polyps were recruited in this study and under NBI examination.The pit pattern was divided into type A and B according to modified Kudo pit pattern classification.And the vascular pattern was classified into three types,type Ⅰ with invisible microvascular,type Ⅱ with even microvascular arranged along pit and type Ⅲ with uneven microvascular and irregular arranged.The differences of morphological and microvascular characteristics between hyperplastic polyps and CA were compared and the inter-observer consistency of NBI without magnification endoscopy was evaluated.Results Overall,87 patients with 107 polyps (73 CAs,34 hyperplastic polyps) underwent NBI without magnification endoscopy examination.The maximum diameter and the proportion of polyps with sublobe was higher in CA group than that of hyperplastic polyps group (P =0.0023 and 0.0047).In CA group,most pit shapes were type B (86.3％,63/73),and most vascular pattern types were Ⅱ/Ⅲ (82.2％,60/73).The sensitivity,specificity and accuracy of CA diagnosed with features of type B pit shape or Ⅱ/Ⅲ vascular pattern type was 97.3％,82.4％ and 92.5％.The sensitivity,specificity and accuracy of CA diagnosed with combined features of type B pit shape and Ⅱ/Ⅲ vascular pattern type was 71.2％,91.2％ and 77.6％.The mean kappa value of inter-observer consistency was 0.761.Conclusions There are differences in pit shapes and vascular pattern characteristics between CA and hyperplastic polyps.According to these two facts,CA and hyperplastic polyps can be initially differential diagnosed by NBI without magnification endoscopy.