共聚焦激光微探头与染色放大内镜对肠道息肉性质判断的比较分析

Comparison between probe-based confocal laser endomicroscopy and magnifying chromoendoscopy for classification of colorectal polyps

目的比较共聚焦激光微探头与染色放大内镜结合腺管开口分型对肠道息肉性质判定的诊断价值。方法2009年12月至2010年1月间接受内镜检查发现肠道息肉的16例患者分别进行染色放大内镜检查，根据腺管开口分型判定息肉性质，然后进行共聚焦激光微探头检查，根据共聚焦激光内镜图像判定息肉性质，以病理结果作为金标准对照，比较二者判断肿瘤性病变的敏感性和特异性。结果在16例患者共发现肠道息肉26颗，与病理相比，染色放大内镜对肿瘤性病变判定的敏感性为94．1％，特异性为77．8％，阳性预测值为88．8％，阴性预测值为87．5％，诊断符合率为88．4％；共聚焦激光微探头对肿瘤性病变判定的敏感性为100．0％，特异性为88．8％，阳性预测值为94．4％，阴性预测值为100．0％，诊断符合率为96．1％，二者相比差异无统计学意义。结论共聚焦激光微探头对肠道肿瘤性病变的判定与染色放大内镜相近，在内镜检查时可作为一种新型、可靠的及时判定息肉性质检查方法。

Objective To compare the diagnostic value of magnifying chromoendoscopy with probe- based confocal laser endomicroscopy （pCLE） for differentiation of neoplastic from non-neoplastic colorectal polyps. Methods A total of 16 consecutive patients, who were diagnosed as having polyps with endoscopy between December 2009 and January 2010 at Nanfang Hospital, were included in this study, The pit pattern of the polyp was first determined with magnifying chromoendoscopy in all patients. Then, confocal images of the polyps were recorded and subsequently analyzed offline. Using pathological diagnosis as golden standard, the sensitivity and specificity of the two methods were compared. Results A total of 26 polyps from 16 patients were found. The sensitivity, specificity, positive predictive value, negative predictive value and accu- racy of magnifying chromoendoscopy was 94. 1%, 77. 8%, 88, 8%, 87.5% and 88.4%, respectively, while those of pCLE were 100. 0% , 88.8% , 94. 4% , 100. 0% and 96. 1% , respectively. There was no significant difference between pCLE and magnifying chromoendoscopy. Conclusion In differentiation between neoplastic and non-neoplastic colorectal lesions, pCLE shows higher sensitivity and specificity than does magnifying chromoendoscopy, although without significant difference, pCLE can be used as a new real time method to determine the property of colorectal polyps.