蓝光成像结合佐野分型对结直肠侧向发育型肿物的诊断价值

The diagnostic performance of blue laser imaging combined capillary pattern for colorectal laterally spreading tumors

目的探讨蓝光成像(BLI)结合佐野分型对结直肠侧向发育型肿物(LSTs)的诊断价值。方法对肠镜检查发现的172处结直肠侧向发育型肿物的进行BLI观察,精细评估病灶表面的血管形态,根据佐野分型(CP)判断病变的性质,与内镜下切除或外科手术后的病理结果进行对比分析。结果CP 1型诊断增生性病变或锯齿状病变(HP/SSP)的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)、准确率分别为50.0%、98.8%、60.0%、98.2%和97.1%。CP 2型诊断低度不典型增生(LGD)的敏感度、特异度、PPV、NPV、准确率分别为93.6%、88.5%、90.7%、92.0%和91.3%。CP 3A型诊断高度不典型增生(HGD)及黏膜内癌或黏膜下浸润癌但浸润深度小于1000μm(m-SMs)的敏感度、特异度、PPV、NPV、准确率分别为86.4%、93.4%、89.1%、91.7%和90.7%。CP 3B型诊断黏膜下浸润癌浸润深度超过1000μm(SMd)的敏感度、特异度、PPV、NPV、准确率分别为50.0%、97.6%、33.3%、98.8%和96.5%。结论BLI结合CP分型可较好的区分结直肠肿瘤性LSTs和非肿瘤性LSTs,对于结直肠LSTs的浸润深度判断良好,可以指导治疗策略选择。

Objective To investigate the diagnostic efficacy of blue laser imaging in distinguishing neoplastic from non-neoplastic colorectal laterally spreading tumors,using capillary pattern(CP)classification system.Methods A total of 172 colorectal laterally spreading tumors were enrolled in this study.Each lesion was observed by blue light imaging and the histology was predicted according to CP classification system.The results were compared with histologic findings.Results The diagnostic sensitivity,specificity,PPV,NPV and accuracy of Type 1 were 50.0%,98.8%,60.0%,98.2%and 97.1%,respectively.The diagnostic sensitivity,specificity,PPV,NPV and accuracy of Type 2 were 93.6%、88.5%、90.7%、92.0%and 91.3%,respectively.The diagnostic sensitivity,specificity,PPV,NPV and accuracy of Type 3A were 86.4%,93.4%,89.1%,91.7%and 90.7%,respectively.The diagnostic sensitivity,specificity,PPV,NPV and accuracy of Type 3B were 50.0%,97.6%,33.3%,98.8%and 96.5%,respectively.Conclusion Blue laser imaging combined CP classification system is effective in distinguishing neoplastic from non-neoplastic colorectal laterally spreading tumors.Further,it is effective to identify the lesions with deeper submucosal invasion.