基于蓝光成像放大结肠镜的JNET分型对结直肠肿瘤性病变诊断价值的研究  

Diagnostic value of JNET classification in blue-laser imaging magnifying endoscopy for colorectal neoplastic lesions

作　　者：王丽 林香春 张蕾[1] 李欣 白鹏 杨雪松[1] 王妍 范雪[1] 丁一鸣[1] Wang Li;Lin Xiangchun;Zhang Lei;Li Xin;Bai Peng;Yang Xuesong;Wang Yan;Fan Xue;Ding Yiming(Department of Gastroenterology,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院消化内科,102206

出　　处：《中华消化内镜杂志》2020年第4期262-266,共5页Chinese Journal of Digestive Endoscopy

基　　金：北京大学国际医院院内科研基金(YN2016ZD02)。

摘　　要：目的探讨蓝光成像放大内镜(blue-laser imaging magnifying endoscope,BLI-ME)下JNET(Japan NBI Expert Team)分型对结直肠肿瘤性病变的诊断效力。方法选取2016年9月—2018年12月间入院接受蓝光成像放大精查患者的内镜图片,4位高年资内镜医师对上述病变图片进行JNET分型并预测其病理类型。以病理结果为金标准评估读片的诊断效力。结果入选34例患者的40个病变,包括非肿瘤性病变3个、腺瘤20个、高级别上皮内瘤变/黏膜下浅层癌10个、黏膜下深层癌7个。4位医师诊断准确率为75.00%~87.50%,JNET各型准确率为65.38%~95.89%。分别计算JNET各型的诊断效力,灵敏度为60.71%~91.67%,特异度为84.17%~97.73%,阳性预测值为63.46%~95.89%,阴性预测值为88.51%~99.31%;对于表面结构判断的信心为73.08%~100.00%,表面微血管形态信心80.77%~100.00%,总体分型信心67.31%~100.00%。任意两位医师间契合度Kappa值为0.630~0.887,4位医师总体相关系数为0.880。结论基于蓝光成像放大观察对结直肠肿瘤性病变进行JNET分型具有较好的诊断能力。Objective To investigate the diagnostic value of Japan NBI Expert Team(JNET)classification with blue-laser imaging magnifying endoscopy(BLI-ME)for colorectal neoplastic lesions.Methods Data of 40 colorectal neoplastic lesions in 34 patients that received BLI-ME from September 2016 to December 2018 in Peking University International Hospital were reviewed and endoscopic images from those lesions were selected.Four senior endoscopists analyzed and classified these images according to the JNET criteria and determined the possible pathologic type.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of JNET classification under BLI-ME system were calculated with final pathologic results as the golden standard.Results Of all the 40 lesions,there were 3 non-cancerous lesions,20 adenoma,10 high grade intraepithelial neoplasia/submucosal-superficial lesions and 7 submucosal-deep lesions.The accuracy of 4 endoscopists was 75.00%-87.50%,and 65.38%-95.89%for different JNET types.For each JNET type,the sensitivity was 60.71%-91.67%,specificity was 84.17%-97.73%,PPV was 63.46%-95.89%,and NPV was 88.51%-99.31%.For the 4 endoscopists,the assurance rate of surface pattern was 73.08%-100.00%,80.77%-100.00%for deciding vascular pattern,and 67.31%-100.00%for deciding final JNET type.The Kappa value between any two endoscopists was 0.630-0.887,and the interclass correlation coefficient for all results was 0.880.Conclusion JNET classification shows significant diagnostic value under BLI-ME system for colorectal neoplastic lesions.

关 键 词：结直肠肿瘤 早期诊断 内窥镜检查 蓝光成像 JNET分型 

分 类 号：R735[医药卫生—肿瘤]