白光结合窄带成像技术鉴别结直肠无蒂锯齿状腺瘤和增生性息肉的研究

Diagnostic value of white light endoscopy and narrow band imaging for colorectal sessile serrated adenoma and hyperplastic polyp

目的探讨如何应用白光内镜和窄带成像技术（NBI）鉴别结直肠无蒂锯齿状腺瘤（SSA）和体积较大的增生性息肉（HP）。方法回顾性分析2015年1月至2015年12月在北京协和医院消化内镜中心接受结直肠癌内镜筛查的953例患者资料，应用白光和NBI比较SSA和HP的内镜特征，包括部位、大小、形态、表面黏液、NICE分型和曲张微血管（VMV）。结果953例患者经结肠镜检查发现28例（2．9％）SSA和25例（2．6％）直径≥0．5cm的HP。病变位于右半结肠、直径≥1．0cm和具有VMV这3项特征在SSA组和HP组间差异有统计学意义（P〈0．05），上述3项指标诊断SSA的敏感度分别为89．3％、67．9％和46．4％，特异度分别为64．0％、76．0％和84．0％，诊断准确率分别为77．4％、71．7％和64．2％，3项指标联合检测（满足至少2项）诊断SSA的敏感度为75．0％，特异度为88．0％，诊断准确率为81．1％。结论通过白光内镜和NBI，综合分析病变部位、大小和表面微血管形态可有效区分SSA和体积较大的HP。

Objective To differentiate colorectal sessile serrated adenoma （SSA） and large hyperplastic polyp （HP） with white light endoscopy and narrow band imaging. Methods Retrospective analysis was performed on the clinical data of 953 patients who underwent endoscopic screening for colorectal cancer at digestive endoscopy center of Peking Union Medical College Hospital from January 2015 to December 2015. Endoscopic features were compared with white light endoscopy and narrow band imaging between SSA and large HP in location, size, Paris classification, surface mucus, NICE classification and varicose microvascular vessel （VMV）. Results A total of 28 （ 2. 9%） SSAs and 25 （ 2. 6%） HPs of diameter not less than 0. 5 cm were detected in the total of 953 patients. Statistically significant difference was found in right hemi-colon, diameter not less than 1.0 cm and VMV in two groups （P 〈 0. 05 ）. The sensitivities of the above three markers for SSA were 89. 3%, 67.9% and 46.4% respectively. The specificities were 64. 0%, 76. 0% and 84.0% respectively. Diagnostic accuracies were 77.4%, 71.7% and 64. 2% respectively. And the sensitivity, specificity and accuracy of three markers combined （ at least two markers） were 75.0%, 88.0% and 81.1%, respectively. Conclusion SSA and large HP could be differentiated with a systemic consideration of lesion location, size, and surface of microvessels by using white light endoscopy and image-enhanced technique.