内镜下结肠息肉巴黎分型与NICE分型的诊断价值

Diagnostic value of Paris classification and NICE classification of colonic polyps unde r endoscopic

目的探讨息肉大小、形态(巴黎分型)、表面结构等(NICE分型)对结直肠腺瘤性息肉的诊断价值。方法收集497例患者在内镜下的结直肠息肉图像,以病理检查结果为金标准评估白光内镜(white light endoscopy,WLE)下巴黎分型与窄带成像(narrow-band imaging,NBI)下NICE分型对不同大小息肉的诊断效果。结果直径<5 mm对腺瘤的预测值为55.3%;直径5~10 mm对腺瘤的预测值为79.2%,两组比较,差异有统计学意义(P<0.05)。巴黎Ⅰsp型、Ⅰp型对腺瘤的预测值高,分别为88.5%、88.2%,Ⅰs型对腺瘤预测值为73.2%。当息肉直径<5 mm时,巴黎分型的灵敏度为50.7%、特异度为69.9%,NICE分型的灵敏度为90.7%、特异度为95.6%;当息肉直径≥5 mm时,巴黎分型的灵敏度为95.7%、特异度为27.0%,NICE分型的灵敏度为98.6%、特异度为70.3%;差异有统计学意义(P<0.05)。当息肉直径<5 mm时,在NICE分型的基础上联合巴黎分型的诊断结果差异无统计学意义(P>0.05);当息肉直径≥5 mm时,NICE 1型+巴黎Ⅰsp/Ⅰp型对非腺瘤的预测值显著低于NICE 1型+巴黎Ⅰs型、Ⅱa型(P=0.040);NICE 2型+巴黎Ⅱa型对腺瘤性息肉的预测值显著低于NICE 2型+巴黎Ⅰs型、Ⅰsp/Ⅰp型(P=0.012)。结论单独应用NICE分型的诊断效果明显优于单独应用巴黎分型;对于直径<5 mm的息肉,可以单独应用NICE分型,而对于直径≥5 mm的息肉,联合应用NICE分型和巴黎分型可以进一步提高对息肉性质的预测效果;对于直径≥5 mm的NICE 1型+巴黎Ⅰsp/Ⅰp型的息肉以及NICE 2型+巴黎Ⅱa型的息肉,病理检查仍是必要的。

Objective To investigate the diagnostic value of polyp size, shape(Paris classification) and surface structure(NICE classification) in colorectal adenomatous polyps.Methods Endoscopic images of colorectal polyps of 497 patients were collected, histopathological results, the gold standard was used to evaluate the diagnostic performance of Paris classification and NICE classification. Results The predictive value of <5 mm diameter for adenoma was 55.3%, and that of 5-10 mm diameter for adenoma was 79.2%. There was significant difference between the two groups(P<0.05). Paris type Ⅰsp and type Ⅰp had high predictive values for adenomas, which were 88.5% and 88.2%, respectively, while the predictive value of type Ⅰs for adenoma was 73.2%. For polyps <5 mm in diameter, the sensitivity and specificity of Paris classification were 50.7% and 69.9%, while those of NICE classification were 90.7% and 95.6%. For polyps ≥5 mm in diameter, the sensitivity and specificity of Paris classification were 95.7% and 27.0%, while those of NICE classification were 98.6% and 70.3%. There was significant difference between the two diagnostic results(P<0.05). For diagnosing polyps <5 mm in diameter, there was no significant difference among Paris subtypes on the basis of NICE classification(P>0.05). For diagnosing polyps ≥5 mm in diameter, the predictive value of the combination of NICE 1 classification and Paris Ⅰsp/Ⅰp classification for non-adenoma was significantly lower than that of the combination of NICE 1 classification and Paris Ⅰs or Ⅱa classification(P=0.040), and the predictive value of the combination of NICE 2 classification and Paris Ⅱa classification for adenoma was significantly lower than that of the combination of NICE 2 classification and Paris Ⅰs, Ⅰsp/Ⅰp classification(P=0.012). Conclusion The diagnostic performance of NICE classification is significantly better than that of Paris classification independently. For polyps with diameter <5 mm, we recommend using NICE classification. For polyps with diameter ≥5 mm, we recommend combining NICE classification with Paris classification to further improve the predictive value. For polyps with diameter ≥5 mm, histopathological examination is still necessary for the combination of NICE 1 classification and Paris Ⅰsp/Ⅰp classification and the combination of NICE 2 classification and Paris Ⅱa classification.