i-Scan联合放大内镜图像强化在大肠肿瘤精确诊断中的应用

摘要

目的：研究数字染色内镜(i-Scan)联合放大内镜进行图像强化在大肠肿瘤精确诊断中的应用效果。方法1200例行结肠镜检查的患者作为研究对象,利用高清晰电子结肠镜筛查大肠病变,发现疑似病变后依次进行白光内镜模式、i-Scan模式、白光内镜+放大内镜模式、i-Scan+放大内镜模式观察,分别对各种模式下大肠病变进行定性诊断。以病理组织学诊断为金标准,比较各种内镜检查模式预测结直肠病变性质的敏感性、特异性、准确性、阴性预测值和阳性预测值。结果经病理组织检验,854例为阳性,346例为阴性。i-Scan+放大内镜模式的敏感性、特异性、准确性、阴性预测值和阳性预测值分别为88.5%、93.9%、90.1%、76.8%、97.3%均远高于白光内镜模式(68.6%、63.9%、67.3%、45.2%、82.4%)、i-Scan模式(77.9%、74.0%、76.8%、57.5%、88.1%)、白光内镜+放大内镜模式(75.5%、72.0%、74.5%、54.4%、86.9%),比较差异具有统计学意义(P<0.05)。结论i-Scan结合放大内镜进行图像强化有利于观察大肠表面的血管和腺管开口类型,其敏感性、特异性、准确性均较高,为大肠肿瘤的内镜诊断和治疗提供一种新的、简单有效的方法,值得临床推广应用。%ObjectiveTo research application effect by digital chromoendoscopy (i-Scan) combined with magnification endoscopy for image intensification in precise diagnosis of colorectal neoplasms.MethodsA total of 1200 patients in colonoscopy examination as study subjects received high definition electronic colonoscope to screen intestinal lesion, followed by white light endoscopy pattern, i-Scan pattern, white light endoscopy + magnification endoscopy pattern, and i-Scan + magnification endoscopy pattern for observing suspected lesion. Qualitative diagnosis was made on intestinal lesion under each pattern. Pathologic histological diagnosis was taken as golden standard to compare sensitivity, specificity, accuracy, negative predictive value and positive predictive value by each pattern in predicting rectal lesion nature.ResultsThere were 854 positive cases and 346 negative cases in pathologic histological detection. Sensitivity, specificity, accuracy, negative predictive value and positive predictive value of i-Scan + magnification endoscopy pattern were respectively 88.5%, 93.9%, 90.1%, 76.8% and 97.3%, which were all higher than those in white light endoscopy pattern (68.6%, 63.9%, 67.3%, 45.2%, 82.4%), i-Scan pattern (77.9%, 74.0%, 76.8%, 57.5%, 88.1%), white light endoscopy + magnification endoscopy pattern (75.5%, 72.0%, 74.5%, 54.4%, 86.9%), and their difference had statistical significance (P<0.05).Conclusion Combination of i-Scan and magnification endoscopy is helpful to observe intestinal surface vessel and glandular tube open types, along with high sensitivity, specificity and accuracy. As a new, convenient and effective method in diagnosing and treating colorectal neoplasms by endoscope, this method is worth clinical promotion and application.