窄带成像技术在结直肠增生性病变诊断中的临床应用价值

目的探讨窄带成像内镜和染色内镜在结直肠增生性病变诊断中的临床应用价值。方法57例患者71处病灶分别在常规内镜、NBI内镜及靛胭脂染色内镜模式下进行观察，对病灶的大体轮廓、腺管开口及血管形态进行观察及分析，判别病灶为肿瘤性或非肿瘤性病灶，并将结果与病理诊断结果相比较。结果常规内镜检查发现病灶65处，检出率91．5％；NBI及靛胭脂染色内镜发现所有病灶，检出率100％。在病变轮廓和血管形态图像观察方面，NBI明显优于常规内镜和靛胭脂染色内镜：腺管开口形态图像显示NBI优于常规内镜，但与靛胭脂染色内镜无显著差别。NBI内镜判别结直肠肿瘤或非肿瘤性病变的病理符合率、敏感度、特异性分别为：91．5％（65／71）、81．8％（18／22）、95．9％（47／49）；与靛胭脂染色内镜88．7％（63／71）、77．3％（17／22）、93．9％（46／49）无显著差异；但明显优于常规内镜。结论NBI内镜对结直肠增生性病变，尤其是肿瘤性、非肿瘤性病变的鉴别优于常规内镜检查，与染色内镜相似能更为清晰地显示病变轮廓、腺管开口及微血管形态；可以及时鉴别增生性病变的性质、对指导活检、确定治疗策略均有非常重要的临床意义，对结直肠癌的早发现、早预防具有重要意义。

窄带成像内镜、染色内镜及常规内镜模式诊断结直肠增生性病变的应用价值比较研究

目的:探讨窄带成像内镜(NBI)、染色内镜及常规内镜模式鉴别诊断非肿瘤性、肿瘤性结直肠增生性病变的应用价值。方法:选择2017年2月至2019年3月西安市中心医院消化科收治的结直肠增生性病变患者,均行NBI、染色内镜、常规内镜检查。比较三种模式图像清晰度以及鉴别诊断非肿瘤性、肿瘤性结直肠增生性病变的效能。结果:NBI、染色内镜模式图像质量评分分布优于常规内镜(P<0.05),NBI图像质量评分分布优于染色内镜模式(P<0.05)。以病理结果为准,常规内镜结直肠增生性病变检出率73.13%,NBI 91.04%,染色内镜96.26%,NBI、染色内镜结直肠增生性病变检出率高于常规内镜(P<0.05),NBI、染色内镜比较无统计学差异(P>0.05)。NBI模式下检测NBI分型与病理组织学结果一致性较好(kappa值=0.801,P<0.05)。NBI、染色内镜诊断肿瘤性结直肠增生性病变的灵敏度、特异度、阳性预测值、阴性预测值、准确度均明显高于常规内镜,染色内镜、NBI、常规内镜诊断肿瘤性结直肠增生性病变的曲线下面积(AUC)分别为0.844(95%CI:0.812~0.956)、0.921(95%CI:0.860~0.982)、0.750(95%CI:0.651~0.848)。结论:NBI、染色内镜在鉴别非肿瘤性和肿瘤性结直肠增生性病变方面效能相似,均优于常规内镜,NBI分型与病理组织学结果一致性高,更适合结直肠增生性病变的鉴别诊断。

Muscularis mucosae in desmoplastic stroma formation of early invasive rectal adenocarcinoma

The origin of myofibroblasts or myofibroblastic cells in the desmoplastic stroma associated with carcinoma invasion has been controversial. In the early invasive area of a rectal adenocarcinoma reported here, an obvious transition between the muscularis mucosa and the bundles of eosinophilic stromal cells observed in the carcinomatous stroma was demonstrated both in morphology and in their cytoskeletal phenotype, which conceivably suggests that the smooth muscle cells of the muscularis mucosa could convert to the eosinophilic stromal cells, namely myofibroblasts. Moreover, type I procollagen was demonstrated in both protein and mRNA levels in the areas of eosinophilic stromal cells with a lesser degree of differentiated smooth muscle phenotype that showed a transition from the muscularis mucosa, implying that the myofibroblastic cells converted from smooth muscle cells of the muscularis mucosa could be responsible for type I collagen production. These findings suggest that the muscularis mucosae may not be a passive barrier through which colorectal carcinomas infiltrate into the submucosa, but may play an active role in the formation and remodeling of tumor stroma.

Is proliferative colonic disease presentation changing?

AIM:To compare the site,age and gender of cases of colorectal cancer(CRC) and polyps in a single referral center in Rome,Italy,during two periods.METHODS:CRC data were collected from surgery/pathology registers,and polyp data from colonoscopy reports.Patients who met the criteria for familial adenomatous polyposis,hereditary non-polyposis colorectal cancer syndrome or inflammatory bowel disease were excluded from the study.Overlap of patients between the two groups(cancers and polyps) was carefully avoided.Theχ 2 statistical test and a regression analysis were performed.RESULTS:Data from a total of 768 patients(352 and 416 patients,respectively,in periods A and B) who underwent surgery for cancer were collected.During the same time periods,a total of 1693 polyps were analyzed from 978 patients with complete colonoscopies(428 polyps from 273 patients during period A and 1265 polyps from 705 patients during period B).A proximal shift in cancer occurred during the latter years for both sexes,but particularly in males.Proximal cancer increased > 3-fold in period B compared to period A in males [odds ratio(OR) 3.31,95%CI:2.00-5.47;P < 0.0001).A similar proximal shift was observed for polyps,particularly in males(OR 1.87,95%CI:1.23-2.87;P < 0.0038),but also in females(OR 1.62,95%CI:0.96-2.73;P < 0.07).CONCLUSION:The prevalence of proximal proliferative colonic lesions seems to have increased over the last decade,particularly in males.