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。

Comparative Study on the Application Value of Narrowband Endoscopic, Chromoendoscopy and Conventional Endoscopy Modes in the Diagnosis of Colorectal Hyperplastic Lesions

Objective: To investigate the value of Narrowband endoscopic(NBI), chromoendoscopy and conventional endoscopy modes in the differential diagnosis of non-neoplastic and neoplastic colorectal hyperplastic lesions. Methods: Patients with colorectal hyperplastic lesions who were admitted to the department of gastroenterology, Xi ’an central hospital from February 2017 to March 2019 were selected, and they were all underwent NBI, chromoendoscopy and conventional endoscopy. The image definition of the three modes and the differential diagnosis of non-neoplastic and neoplastic colorectal hyperplastic lesions were compared. Results: The image quality score distribution of NBI and chromoendoscopy were better than that of conventional endoscopy(P<0.05), and the image quality score distribution of NBI was better than that of chromoendoscopy(P<0.05). The pathological results shall prevail, the detection rate of conventional endoscopic colorectal hyperplastic lesions was 73.13%, NBI 91.04% and chromoendoscopy 96.26%. The detection rate of NBI and chromoendoscopy were higher than that of conventional endoscopy(P<0.05), there was no significant difference between NBI and chromoendoscopy(P>0.05). NBI typing in NBI mode was consistent with histopathological results(kappa value=0.801, P<0.05). The sensitivity,specificity, positive predictive value, negative predictive value and accuracy of NBI and chromoendoscopy in the diagnosis of tumor colorectal hyperplasia were significantly higher than those of conventional endoscopy. The area under curve(AUC) of neoplastic colorectal hyperplastic lesions diagnosed by chromoendoscopy, NBI and conventional endoscopy were 0.844(95%CI: 0.812~0.956), 0.921(95%CI: 0.860~0.982), and 0.750(95%CI: 0.651~0.848), respectively. Conclusion: NBI and chromoendoscopy have similar efficacy in differentiating non-neoplastic and neoplastic colorectal hyperplastic lesions, both of them are better than conventional endoscopy. NBI typing is highly consistent with histopathology results, which is more suitable for the differential diagnosis of colorectal proliferative lesions.