利用窄带成像技术观察毛细血管形态在结直肠息肉样病变鉴别诊断中的价值

Narrow-band imaging of meshed capillary vessels for differential diagnosis of colorectal lesions

目的:探讨利用窄带成像技术(narrow bandimaging,NBI)观察毛细血管形态(capillarypatterns,CP)对结直肠息肉样病变鉴别诊断的价值.方法:75例患者接受NBI结肠镜检查共发现病变部位116处.根据Yoshiki的分型方法,将结直肠病变的CP分为6种:蜂窝状结构型、模糊结构型、网状结构型、密度增高型、不规则结构型、稀疏结构型.利用NBI下观察到的CP进行鉴别诊断,并与病理结果对照判定其敏感性、特异性及准确率.结果:在116例结直肠病变中增生性息肉毛细血管形态多表现为模糊结构型,而腺瘤性息肉的毛细血管形态表现为网状结构型和密度增高型,癌症的毛细血管形态多表现为不规则型和稀疏结构型.利用此分型方法鉴别肿瘤性病变和非肿瘤性病变的敏感性和特异性分别是94.6%和78.6%,准确性88.8%,阳性预测值(positive predictive value,PPV)88.6%,阴性预测值(negative predictivevalue,NPV)89.2%(P<0.01).同样,对于腺瘤性息肉和癌症的鉴别诊断的敏感性和特异性分别是100.0%和87.5%,准确性91.4%(P<0.01).将直径<10 mm的小息肉按毛细血管的有无进行鉴别诊断的敏感性和特异性分别是89.7%和80.5%,PPV81.4%,NPV89.2%,准确性85.0%(P<0.01).结论:NBI结肠镜观察结直肠病变CP对于鉴别肿瘤性病变与非肿瘤性病变,以及腺瘤性息肉与癌症具有可靠的诊断价值.对于直径<10 m m小息肉的肿瘤性及非肿瘤性的鉴别诊断方面NBI结肠镜也具有很好作用.

AIM：To evaluate the value of narrow-band imaging（NBI） in tissue characterization and differential diagnosis. METHODS：A series of 75 patients with 116 colorectal lesions were studied.According to Yoshiki Wada＇s typing method,the vascular patterns of colorectal lesions were divided into six species：honey-comb,faint,network,dense,irregular,and sparse.During NBI,the microvascular architecture on the surface of the detected lesions was observed.Results of NBI were compared with histological results. RESULTS：Most hyperplastic polyps showed a faint pattern.The vascular patterns of adenomas were mainly the network or dense pattern.The major vascular patterns of cancers were the irregular and sparse patterns.When we assumed that the faint pattern was diagnostic for hyperplastic polyps,we could differentiate between neoplastic and non-neoplastic lesions with a sensitivity of 94.6% and a specificity of 78.6%.The accuracy,positive predictive value and negative predictive value of capillary patterns（CP） under NBI were 88.8%,88.6% and 89.2%,respectively（P 0.01）.Likewise,irregular and sparse patterns were assumed to be indices of cancer,and the sensitivity.specificity and accuracy were 100.0%,87.5% and 91.4%,respectively（P 0.01）.When lesions 10 mm were classified into 2 groups：polyps with invisible or faintly visible meshed capillary（MC） vessels as nonneoplastic and those with clearly visible MC vessels as neoplastic,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 89.7%,80.5%,81.4%,89.2% and 85.0%,respectively（P 0.01）. CONCLUSION：NBI is valuable for distinguishing between neoplastic and non-neoplastic lesions,as well as between cancers and adenomas,and for differential diagnosis of lesions 10 mm.