窄带成像内镜下结直肠息肉形态特征差异及对息肉性质的鉴别价值

Morphological Differences of Colorectal Polyps Under NBI Endoscopy and Their Diagnostic Value in Polyp Characterization

目的:窄带成像内镜(NBI)下的结直肠息肉形态特征差异及其对息肉性质的鉴别诊断价值。方法:选取齐齐哈尔市第一医院2021年2月至2023年2月接受结直肠内镜检查且确诊为结直肠息肉样病变患者126例(768颗息肉)作为研究对象,统计分析检出息肉的大小、形态、表面黏膜情况,根据病理学结果将息肉分为非瘤性息肉和癌前病变息肉,并计算NICE分型判别息肉性质的价值,并绘制ROC曲线。结果:高级别上皮瘤变息肉中直径≥1.0cm的息肉占比显著高于管状腺瘤、炎性息肉、炎性息肉(P值均<0.003),管状绒毛状腺瘤中直径≥1.0cm的息肉占比显著大于炎性息肉、增生性息肉(P值均<0.003);管状绒毛状腺瘤中直径≥1.0cm的息肉占比显著大于炎性息肉(P<0.003);高级别上皮瘤变息肉的山田分型与绒毛状腺瘤、增生性息肉的山田分型比较,差异具有统计学意义(P值均<0.003);绒毛状腺瘤中分叶状息肉占比显著高于管状腺瘤、高级别上皮瘤变、炎性息肉、管状绒毛状腺瘤、增生性息肉(P值均<0.003);管状腺瘤、炎性息肉、管状绒毛状腺瘤、增生性息肉黏膜表面光滑的占比率显著高于绒毛状腺瘤、高级别上皮瘤变(P值均<0.003);NICE分型标准判断结直肠息肉瘤性或非瘤性息肉的灵敏度为88.62%、特异度为90.94%、漏诊率为11.38%、误诊率为9.06%。结论:在NBI下,不同病理学类型的结直肠息肉形态特征、大小、表面黏膜特征相比较有显著差异,且NBI检查对于鉴别诊断结直肠息肉性质具有较高的临床应用价值。

Objective:To investigate the morphological differences of colorectal polyps under Narrow Band Imaging(NBI)endoscopy and evaluate their diagnostic value in distinguishing the nature of polyps.Methods:A total of 126 patients(768 polyps)diagnosed with colorectal polyp-like lesions during colonoscopy from February 2021 to February 2023 at the First Hospital of Qiqihar were included.The size,morphology,and surface mucosa of polyps were analyzed.Polyps were classified into non-neoplastic polyps and adenomas based on pathological results.The diagnostic value of the NICE classification in determining polyp nature was calculated,and ROC curves were plotted.Results:The proportion of polyps with a diameter≥1.0 cm in high-grade epithelial dysplasia adenomas was significantly higher than in tubular adenomas,inflammatory polyps,and hyperplastic polyps(P<0.003).The proportion of polyps with a diameter≥1.0 cm in tubular-villous adenomas was significantly higher than in inflammatory polyps and hyperplastic polyps(P<0.003).The proportion of polyps with a diameter≥1.0 cm in tubular-villous adenomas was significantly higher than in inflammatory polyps(P<0.003).The Yamada classification of high-grade epithelial dysplasia adenomas differed significantly from that of villous adenomas and hyperplastic polyps(P<0.003).The proportion of lobulated polyps in villous adenomas was significantly higher than in tubular adenomas,high-grade epithelial dysplasia adenomas,inflammatory polyps,tubular-villous adenomas,and hyperplastic polyps(P<0.003).The percentage of polyps with smooth mucosal surfaces in tubular adenomas,inflammatory polyps,tubular-villous adenomas,and hyperplastic polyps was significantly higher than in villous adenomas and high-grade epithelial dysplasia adenomas(P<0.003).The sensitivity,specificity,missed diagnosis rate,and misdiagnosis rate of NICE classification in determining the nature of colorectal polyps were 88.62%,90.94%,11.38%,and 9.06%,respectively.Conclusion:Under NBI,there are significant differences in the morphological characteristics,size and surface mucosal characteristics of colorectal polyps in different pathological types,and NBI examination has a high clinical application value in the differential diagnosis of colorectal polyps.