窄带成像国际结直肠内镜分型在结直肠病变诊治中的价值*

NICE classification in diagnosis and treatment of colorectal lesions*

摘要:

评价非放大内镜下窄带成像（NBI）国际结直肠内镜分型（NICE）实时预判结直肠病变性质并指导治疗的价值。方法 对结直肠隆起或扁平隆起性的黏膜病变采用NICE分型进行实时预判分类和处置建议，依据活检、内镜或外科手术后的病理结果评价NICE分型的敏感性、特异性、准确性、阳性预测值和阴性预测值。进行观察一致性检验。结果 共计241例患者307处病变被纳入分析。其中非肿瘤性病变12.07%、腺瘤性病变82.07%、癌5.86%，病变直径0.1～6.0 cm。NICE分型预判肿瘤性及非肿瘤性病变的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为97.04%、89.19%、96.09%、98.50%和80.49%。一致性检验，判断肿瘤性病变和非肿瘤性病变的Kappa值为0.795，判断黏膜下深层病变和黏膜下浅层以上病变的Kappa值为0.875，总的Kappa值为0.814。结论 NICE分型能较准确地实时预判结直肠病变的性质并指导治疗，有利于推广仅将肿瘤性病变纳入内镜下切除或外科手术的适度治疗模式。

Abstract:

To evaluate the efficacy of NICE classification in non-magnifying narrow band imaging for real-time histologic prediction and therapeutic guidance of colorectal lesions. Methods According to NICE classification, histologic prediction and therapeutic guidance were given for raised or flat raised colorectal mucosal lesions. According to pathology following biopsy, endoscopy or surgery, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of NICE classification were valued. The observation consistency test was also carried out. Results 241 patients with 307 lesions were studied. The non-neoplastic lesions were 12.07%, adenomatous lesions were 82.07%, carcinomas were 5.86%. The lesions ranged from 0.1 cm to 6.0 cm in diameter. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of NICE classification in differentiating non-neoplastic and neoplastic lesions were 97.04%, 89.19%, 96.09%, 98.50%, 80.49%. The Kappa of non-neoplastic and neoplastic lesions was 0.795. The Kappa of submucosal deep infiltrating lesions and lesions above superficial submucosa was 0.875. The total Kappa was 0.814. Conclusion NICE classification can accurately predict the histology of colorectal lesions and guide treatments. It is help to the moderate treatment mode in which merely neoplastic lesions are included in endoscopic resections or surgical procedures.