非放大内镜下NICE分型判断结直肠肿瘤性息肉的临床应用价值

Efficacy of NICE classification with non-magnified endoscopy on diagnosis of colorectal tumor

目的评估非放大内镜下窄带成像技术（NBI）国际结直肠内镜分型（NICE分型）系统判断结直肠肿瘤的临床实际应用价值。方法回顾性纳入普通内镜医师行白光结肠镜检查检出、并行NBI观察及NICE分型的224处结直肠息肉资料，对NICE分型结果和内镜或外科手术切除标本的病理结果进行对比分析。结果224处息肉中NICE 1型59处，2型159处，3型6处；病理诊断非肿瘤性息肉58处，肿瘤性息肉166处。依据NICE分型诊断肿瘤性息肉的总体敏感度、特异度、阳性预测值、阴性预测值和准确率分别为91.6%、77.6%、92.1%、76.3%和87.9%。NICE分型预测大息肉（直径〉10 mm）、小息肉（直径〉5-10 mm）和微小息肉（直径≤5 mm）肿瘤性与否的敏感度和准确率分别为100.0%、97.0%、80.9%和95.7%、87.8%、83.3%，诊断准确率随病变直径变小而下降，但差异无统计学意义（P=0.694）。结论临床实际工作中，普通内镜医师利用非放大内镜下NICE分型判断结直肠肿瘤总体准确率较高，具有一定临床推广应用价值。

ObjectiveTo evaluate the diagnostic efficacy of narrow band imaging （NBI） international colorectal endoscopic （NICE） classification in distinguishing neoplastic from non-neoplastic colorectal polyps during routine clinical practice.MethodsA total of 224 lesions detected by white light colonoscopy by non-expert endoscopists were collected in this retrospective study. Each lesion was assessed by NBI and classified by NICE classification. The results were compared with pathological findings from endoscopic or surgical resected specimen.ResultsAmong these 224 polyps, there were 59 of type 1, 159 of type 2 and 6 of type 3 according to NICE classification. There were 58 non-tumorous and 166 tumorous polyps according to pathological diagnosis. The total diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of NICE classification for colorectal tumor were 91.6%, 77.6%, 92.1%, 76.3% and 87.9%, respectively. Diagnostic sensitivity and accuracy in big （〉10 mm in diameter）, small （〉5-10 mm in diameter） and mini （≤5 mm in diameter） polyp groups were 100.0%, 97.0% and 80.9%, as well as 95.7%, 87.8%, and 83.3%, respectively. Diagnostic accuracy showed a decreasing tendency on polyp size, without significant difference between the three groups （P=0.694）.ConclusionNICE classification with non-magnified NBI is effective in distinguishing neoplastic and non-neoplastic colorectal polyps by non-expert endoscopists and is potentially worth popularizing for routine clinical practice.