结直肠无蒂锯齿状腺瘤/ 息肉在白光内镜和窄带成像模式下的形态特征

Morphological features of colorectal sessile serrated adenoma/ polyp under white light endoscopy and narrow band imaging

摘要:

目的 探讨结直肠无蒂锯齿状腺瘤/ 息肉（SSA/P）在白光内镜（WLE）和窄带成像（NBI）模 式下的形态特征及与增生性息肉（HP）的鉴别要点。方法 回顾性分析2014 年1 月-2017 年3 月郑州大 学第二附属医院内镜室检出的SSA/P 的形态特征，与HP 按大小配对进行比较。结果 纳入41 例患者的50 枚SSA/P，43 例患者的50 枚HP。SSA/P 位于右半结肠者多于HP，但差异无统计学意义（16 枚 vs 14 枚， P >0.05）。SSA/P 中呈Ⅰ s 型者11 枚，Ⅱ a 型21 枚，Ⅱ b 型16 枚，LST 型2 枚，HP 中呈Ⅰ s 型者17 枚，Ⅱ a 型25 枚，Ⅱ b 型8 枚，差异无统计学意义（P >0.05）；SSA/P 中表面富于黏液者多于HP（37 枚 vs 11 枚， P <0.05）。NBI 模式：SSA/P 具有红色黏液帽、边界模糊、形态不规则、隐窝内黑点、积云样表面、Ⅱ -O 型腺管开口和表面微血管网的比例均高于HP（P <0.05）。在SSA/P 与HP 的鉴别预测中：隐窝内黑点（OR ^ ： 14.2 ；95%CI ：5.8 ～ 34.7）的灵敏度、特异度、准确性分别是：80.0%、78.0%、79.0%，灵敏度较高；Ⅱ -O 型腺管开口（OR^ ：56.0 ；95%CI ：17.7 ～ 177.6）的灵敏度、特异度、准确性分别是：70.0%、96.0%、83.0%， 特异度较高；红色黏液帽（OR ^ ：9.3 ；95%CI ：3.8 ～ 22.8）的灵敏度、特异度和准确性分别是：64.0%、 84.0%、74.0%，特异度较高；积云样表面（OR ^ ：16.9 ；95%CI ：5.7 ～ 50.7）的灵敏度、特异度和准确性分别 是：52.0%、94.0%、73.0%，特异度较高，灵敏度较低。联合隐窝内黑点和Ⅱ -O 型腺管开口与其他形态特征 对SSA/P 进行诊断预测能提高诊断预测的灵敏度和准确性。结论 研究证实在NBI 模式下SSA/P 相比HP 具 有独特的形态特征。NBI 模式下对SSA/P 形态特征进行观察，可达到鉴别SSA/P 和HP 的目的。隐窝内黑点 和Ⅱ -O 型腺管开口在诊断预测SSA/P 时分别具有较高的灵敏度和特异度，推荐在结肠镜检查时可联合两者 与其他形态特征对SSA/P 进行诊断预测，以达到内镜下筛查诊断SSA/P 的目的。

Abstract:

Objective To investigate the morphological features of colorectal sessile serrated adenoma/ polyp (SSA/P) by white light endoscopy (WLE) and narrow band imaging (NBI). Methods A retrospective analysis was made on the morphological characteristics of SSA/P from January 2014 to March 2017, and compared with HP. Results There were 50 cases of SSA/P from 41 patients and 50 cases of HP from 43 patients. SSA/P located in the right colon was more than HP, but the difference was no statistical significance (16 cases vs 14 cases,P > 0.05). SSA/P have 11 cases of Type Is, 21 cases of Type IIa, 16 cases of Type IIb, 2 cases of Type LST, HP have 17 cases of Type Is, 25 cases of Type IIa, 8 cases of Type IIb, there was no significant difference (P > 0.05); SSA/P has more mucus than HP (37 cases vs 11 cases, P < 0.05). In NBI: The proportion of SSA/P with a red mucus cap, indistinctive borders, irregular shape, black dots inside the crypts, Cloud-like surface, Type II-O pit pattern and varicose microvascular vessels were higher than that of HP (P < 0.05). In the differential prediction of SSA/P and HP: Black dots inside the crypts (OR^ : 14.2; 95%CI: 5.8 ～ 34.7) with higher sensitivity, the sensitivity, specificity and accuracy respectively were 80.0%, 78.0%, 79.0%; Type II-O pit pattern (OR^ : 56.0; 95%CI: 17.7 ~ 177.6) with higher specificity, the sensitivity, specificity and accuracy respectively were: 70.0%, 96.0%, 83.0%; Red mucus cap (OR^ : 9.3; 95%CI: 3.8 ~ 22.8) with high specificity, the sensitivity, specificity and accuracy respectively were 64.0%, 80.0%, 74.0%; Cloud-like surface (OR^ : 16.9; 95%CI: 5.7 ~ 50.7) with high specificity and low sensitivity, the sensitivity, specificity and accuracy respectively were: 52.0%, 94.0%, 73.0%. Combining the black dots inside the crypts and Type II-O pit pattern with other endoscopic features of SSA/P could improve the sensitivity and the accuracy in diagnosis prediction. Conclusion The study has confirmed that SSA/P has unique endoscopic features compared with HP in NBI mode. Observing the morphological characteristics of SSA/P with NBI could achieve the purpose of identifying SSA/P and HP. The black dots inside the crypts and Type II-O pit pattern respectively have higher sensitivity and specificity in diagnosis prediction of SSA/P, so we recommend to combine the two indicators with others endoscopic features of SSA/P to identify SSA/P and HP to achieve the purpose of screening SSA/P in colonoscope examination.