Development of a narrow-band imaging classification to reduce the need for routine biopsies of gastric polyps  

建立一个窄带成像分型以减少胃息肉的常规活检

作　　者：Ivor B.Asztalos Caitlin A.Colling Anna M.Buchner Vinay Chandrasekhara 

机构地区：[1]Department of Pediatrics,Children’s Hospital of Philadelphia,Philadelphia,PA,USA [2]Department of Internal Medicine,Massachusetts General Hospital,Boston,MA,USA [3]Division of Gastroenterology and Hepatology,Hospital of the University of Pennsylvania,Philadelphia,PA,USA [4]Division of Gastroenterology and Hepatology,Mayo Clinic,Rochester,MN,USA

出　　处：《Gastroenterology Report》2021年第3期219-225,I0002,共8页胃肠病学报道（英文）

摘　　要：Background Most incidental gastric polyps identified during upper endoscopy are considered low-risk.However,current guidelines recommend sampling all gastric polyps for histopathologic analysis.We aimed to devise a simple narrow-band imaging(NBI)classification to reduce the need for routine biopsies of low-risk gastric polyps.Methods Pairs of NBI and white-light images were collected from 73 gastric polyps for which concurrent histopathologic diagnosis was available.A diagnostic accuracy cohort study was performed.Two blinded endoscopists independently analysed NBI features of each polyp for color,vessel pattern,surface pattern,and any combinations thereof to develop a classification scheme to differentiate low-risk polyps(fundic-gland or hyperplastic)from high-risk polyps(adenomatous or adenocarcinoma)and fundic-gland polyps(FGPs)from non-FGPs.Results An isolated lacy vessel pattern and a homogenous absence of surface pattern successfully differentiated low-risk from high-risk gastric polyps.Combining both descriptors into a single algorithm resulted in a negative predictive value(NPV)of 100%[95%confidence interval(CI):100%–100%],positive predictive value(PPV)of 13.7%(95%CI:2.6–24.8),sensitivity of 100%(95%CI:100%–100%),and specificity of 53.7%(95%CI:45.3%–62.0%)for high-risk polyps.This would reduce the number of polyps requiring biopsy by 50%,while still capturing all high-risk polyps.Regarding FGPs,using a rule not to biopsy polyps with isolated lacy vessels resulted in a 94.9%NPV(95%CI:89.2%–100%),63.2%PPV(95%CI:47.2%–79.2%),94.8%sensitivity(95%CI:89.5%–100%),and 63.6%specificity(95%CI:51.3%–76.0%)for non-FGPs.Conclusion In this derivation cohort study,NBI is helpful for differentiating between high-risk and low-risk gastric polyps,thereby reducing the need for routine sampling of low-risk polyps.These results need to be validated in a separate test population.背景:上消化道内镜检查时意外发现的胃息肉大多都是低风险的,但目前的指南推荐对所有的胃息肉都进行活检以进行组织病理学分析。我们设计了一个简单的窄带成像(NBI)分型,旨在减少对低危胃息肉的常规活检。方法:筛选出具有组织病理学诊断的73枚息肉,提取其NBI影像和白光影像,进行诊断性队列研究。两名并不清楚息肉性质的内镜医生对每枚息肉的NBI特征进行独立评估,包括颜色、血管模式和表面结构,并将这些特征进行各种组合,从而建立一个分型标准,以鉴别低危息肉(基底腺性或增生性息肉)与高危息肉(腺瘤或腺癌)以及基底腺性息肉(FGP)和非FGP。结果:孤立网状的血管模式和均质或缺失的表面结构可有效鉴别低危与高危胃息肉。将这两个特征相结合来诊断高危息肉,可获得100%的阴性预测值(95%CI:100%-100%),阳性预测值为13.7%(95%CI:2.6%-24.8%),灵敏度和特异度分别为100%(95%CI:100%-100%)和53.7%(95%CI:45.3%-62.0%);可将需要活检的息肉数量减少50%的同时,不会漏掉一例高危息肉。采用孤立网状的血管模式来判断无需活检的FGP,其阴性预测值高达94.9%(95%CI:89.2%-100%),阳性预测值为63.2%(95%CI:47.2%-79.2%),灵敏度和特异度分别为94.8%(95%CI:89.5%-100%)和63.6%(95%CI:51.3%-76.0%)。结论:这项推导性队列研究发现,NBI有助于高危与低危胃息肉的鉴别,从而对减少低危息肉的常规活检。这些结果需要在不同的研究人群中进行验证。

关 键 词：gastric polyps narrow-band imaging gastric cancer MALIGNANCY ENDOSCOPY 

分 类 号：R735.2[医药卫生—肿瘤]