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Background: Real time visual differentiation of colorectal polyps into benign and malignant helps to decide the appropriate treatment strategy and avoid the unnecessary risk associated with endoscopic therapies and need for repeat procedures. The Japan NBI Expert Team (JNET) classification developed in 2014 classifies colorectal polyps into types 1(Hyperplastic polyps including sessile serrated polyps), 2A (low grade dysplasia), 2B (high grade dysplasia/ superficial submucosal invasive carcinomas) and 3 (deep submucosal invasive carcinomas). We conducted this study to evaluate the diagnostic accuracy of the JNET classification for colorectal polyps. Methods: All patients undergoing colonoscopy in a tertiary care Centre in south India from February to July 2020, who had colorectal polyps were included in the study. A prospective image evaluation to identify the JNET class was done by 2 independent observers blinded to the histological diagnosis and the result was compared with the final histopathological diagnosis. Inflammatory polyps were excluded. The collected data was statistically analyzed to assess the diagnostic accuracy. Result: 139 polyps from 102 patients were included in the study. Most common locations were ascending colon (31%) or rectosigmoid (30.3%). 21 polyps were hyperplastic polyps, 78 polyps were LGD, 23 were HGD/SM-S and 17 were SM-D polyps. On NBI imaging, 23, 76, 30, and 10 polyps were classified as JNET types 1, 2a, 2b and 3 respectively. The diagnostic accuracy of JNET classification was 98.5%, 88.4%, 83% and 93.5% respectively. Conclusion: The JNET classification has a high diagnostic accuracy for predicting the histology of colorectal polyps and hence recommended.
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Objective:To evaluate type B2 vessels for predicting the invasion depth of superficial esophageal squamous cell carcinoma (SESCC) under narrow band imaging-magnifying endoscopy (NBI-ME), and to analyse the influencing factors of over-prediction and under-prediction.Methods:A total of 86 SESCC patients with 86 lesions confirmed by postoperative pathology, who underwent NBI-ME to evaluate the invasion depth of esophageal tumor and were observed for type B2 vessels in Department of Digestive Endoscopy of Fujian Provincial Hospital from January 2015 to April 2020, were included in the case-control study. According to the postoperative pathological results, the patients were divided into the correct prediction group ( n=25) and the wrong prediction group ( n=61), and the accuracy of prediction was calculated. The wrong prediction group was further divided into the over-prediction group ( n=49) and the under-prediction group ( n=12) to find the influencing factors of over-prediction and under-prediction, respectively. Further, multivariate Logistic analysis was performed to explore the independent influential factors for the prediction. Results:The accuracy of type B2 vessels under NBI-ME for predicting the invasion depth of SESCC was only 29.07% (25/86), and the over-prediction rate and under-prediction rates were 56.98% (49/86) and 13.95% (12/86), respectively. Univariate analysis showed that the classification of type B2 area ( χ2=36.25, P<0.001), the distinct endoscopic features (nodules, thickening and obvious depression, χ2=22.90, P<0.001), and inflammation around type B2 vessels ( χ2=9.54, P=0.004) were related to the over-prediction of the invasion depth of SESCC, and the distinct endoscopic features were related to the under-prediction of the invasion depth ( P=0.016). Multivariate Logistic regression analysis showed that B2-narrow (type B2 area ≤5 mm) ( P<0.001, OR=241.988,95% CI:15.229-3 845.252) and inflammation around type B2 vessels ( P=0.033, OR=12.801, 95% CI: 1.226-133.713) were independent risk factors for over-predicting the invasion depth of SESCC, while the distinct endoscopic features were independent protective factors for over-prediction ( P<0.001, OR=0.012, 95% CI: 0.001-0.150). The distinct endoscopic feature was an independent risk factor for under-predicting invasion depth of SESCC with type B2 vessels ( P=0.027, OR=7.899, 95% CI: 1.259-49.565). Conclusion:The accuracy of predicting the invasion depth of SESCC is low only based on type B2 vessels in NBI-ME, and over-prediction is prone to occur. B2-narrow, inflammation around type B2 vessels and without nodules, thickening and obvious depression are closely related to the over-prediction of invasion depth of SESCC by type B2 in NBI-ME, and nodules, thickening and obvious depression are closely associated with the under-prediction. However, whether the combined assessment of type B2 vessels under NBI-ME and endoscopic manifestation can improve the accuracy of prediction needs to be confirmed by further studies.
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: To evaluate the application of medical magnifying loupes in diagnosis of oral mucosal diseases. Twenty-four patients with plaque-type oral lichen planus or homogeneous oral leukoplakia were inspected by naked eyes or assistance with magnifying loupes. Histopathological results were used as the gold standard to evaluate the sensitivity, specificity and accuracy of the two methods in clinical diagnosis. Questionnaires were used to evaluate the subjective effect of magnifying loupes on the diagnosis efficiency of oral mucosal diseases and to explore the most suitable parameters for application. The sensitivity, specificity and accuracy of medical magnifying loupes for the identification of plaque-type oral lichen planus and homogeneous oral leukoplakia were 94.74%, 100.00% and 95.83%, respectively, which were significantly higher than those of naked eye inspection (89.47%, 80.00% and 87.50%). The effective rate of magnifying loupes assisted diagnosis was 91.76% according to physicians' subjective evaluation. The most suitable parameters were 3.5 times magnification and working distance. The medical magnifying loupes can effectively improve the efficiency of the inspection and diagnosis of oral mucosal diseases, and have the characteristics of convenience and real-time. The recommended clinical parameters are 3.5 times magnification and working distance.
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Humans , Efficiency , Lenses , Surveys and QuestionnairesABSTRACT
Objective:To develop early gastric cancer (EGC) detection system of magnifying blue laser imaging (ME-BLI) model and magnifying narrow-band imaging (ME-NBI) model based on deep convolutional neural network, to compare the performance differences of the two models and to explore the effects of training methods on the accuracy.Methods:The images of benign gastric lesions and EGC under ME-BLI and ME-NBI were respectively collected. A total of five data sets and three test sets were collected. Data set 1 included 2 024 noncancerous lesions and 452 EGC images under ME-BLI. Data set 2 included 2 024 noncancerous lesions and 452 EGC images under ME-NBI. Data set 3 was the combination of data set 1 and 2 (a total of 4 048 noncancerous lesions and 904 EGC images under ME-BLI and ME-NBI). Data set 4: on the basis of data set 2, another 62 noncancerous lesions and 2 305 EGC images under ME-NBI were added (2 086 noncancerous lesions and 2 757 EGC images under ME-NBI). Data set 5: on the basis of data set 3, another 62 noncancerous lesions and 2 305 EGC images under ME-NBI were added(4 110 noncancerous lesions and 3 209 EGC images under ME-NBI and ME-BLI). Test set A included 422 noncancerous lesions and 197 EGC images under ME-BLI. Test set B included 422 noncancerous lesions and 197 EGC images under ME-NBI. Test set C was the combination of test set A and B (844 noncancerous and 394 EGC images under ME-BLI and ME-NBI). Five models were constructed according to these five data sets respectively and their performance was evaluated in the three test sets. Per-lesion video was collected and used to compare the performance of deep convolutional neural network models under ME-BLI and ME-NBI for the detection of EGC in clinical environment, and compared with four senior endoscopy doctors. The primary endpoint was the diagnostic accuracy of EGG, sensitivity and specificity. Chi-square test was used for statistical analysis.Results:The performance of model 1 was the best in test set A with the accuracy, sensitivity and specificity of 76.90% (476/619), 63.96% (126/197) and 82.94% (350/422), respectively. The performance of model 2 was the best in test set B with the accuracy, sensitivity and specificity of 86.75% (537/619), 92.89% (183/197) and 83.89% (354/422), respectively. The performance of model 3 was the best in test set B with the accuracy, sensitivity and specificity of 86.91% (538/619), 84.26% (166/197) and 88.15% (372/422), respectively. The performance of model 4 was the best in test set B with the accuracy, sensitivity and specificity of 85.46% (529/619), 95.43% (188/197) and 80.81% (341/422), respectively. The performance of model 5 was the best in test set B, with the accuracy, sensitivity and specificity of 83.52% (517/619), 96.95% (191/197) and 77.25% (326/422), respectively. In terms of image recognition of EGC, the accuracy of models 2 to 5 was higher than that of model 1, and the differences were statistically significant ( χ2=147.90, 149.67, 134.20 and 115.30, all P<0.01). The sensitivity and specificity of models 2 and 3 were higher than those of model 1, the specificity of model 2 was lower than that of model 3, and the differences were statistically significant ( χ2=131.65, 64.15, 207.60, 262.03 and 96.73, all P < 0.01). The sensitivity of models 4 and 5 was higher than those of models 1 to 3, and the specificity of models 4 and 5 was lower than those of models 1 to 3, and the differences were statistically significant ( χ2=151.16, 165.49, 71.35, 112.47, 132.62, 153.14, 176.93, 74.62, 14.09, 15.47, 6.02 and 5.80, all P<0.05). The results of video test based on lesion showed that the average accuracy of doctors 1 to 4 was 68.16%. And the accuracy of models 1 to 5 was 69.47% (66/95), 69.47% (66/95), 70.53% (67/95), 76.84% (73/95) and 80.00% (76/95), respectively. There were no significant differences in the accuracy among models 1 to 5 and between models 1 to 5 and doctors 1 to 4 (all P>0.05). Conclusions:ME-BLI EGC recognition model based on deep learning has good accuracy, but the diagnostic effecacy is sligntly worse than that of ME-NBI model. The effects of EGC recognition model of ME-NBI combined with ME-BLI is better than that of a single model. A more sensitive ME-NBI model can be obtained by increasing the number of ME-NBI images, especially the images of EGG, but the specificity is worse.
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Objective:To analyze and compare the features of undifferentiated-typed early gastric cancer (UD-EGC) and gastric mucosa-associated lymphoid tissue(MALT) lymphoma under white light endoscopy (WLE) and magnifying endoscopy-narrow band imaging (ME-NBI).Methods:Data of patients with complete endoscopic images of WLE and ME-NBI in Shanghai General Hospital, Shanghai Jiao Tong University from March 2015 to July 2019 were retrospectively analyzed.Twenty-six UD-EGC patients and seven gastric MALT lymphoma patients in ⅠE1 stage were included, and the characteristics of the two diseases under WLE and ME-NBI were compared and summarized.Results:There were no significant differences in age, sex or infiltration depth of lesions between the two groups.Under WLE, UD-EGC was often manifested as a single lesion located in the lower part of the stomach, with unclear lesion boundaries. While MALT lymphoma lesions were mostly multifocal with clear boundaries, located in the middle of the stomach. Under ME-NBI, the microsurface pattern of UD-EGC showed dilation or disappearance of areas between the recesses, and the spiral microvascular pattern. However, the microsurface pattern of MALT lymphomas were characterized by " cross-road traffic sign" , " pebble sign" , and the presentation of residual glandular duct at the lesion was similar to that of Helicobacter pylori ( HP)-related gastritis. Furthermore, the microvascular pattern of MALT lymphomas often showed " tree like appearance (TLA)" . After HP eradication therapy, the morphology of microsurface pattern and microvascular pattern in the original lesion area gradually returned to normal. Conclusion:UD-EGC and gastric MALT lymphoma showed particular features in the number, site and boundary under WLE, and they showed significantly different microsurface pattern and microvascular pattern under ME-NBI. Differentiation of the two diseases will help reduce the risk of missed diagnosis and misdiagnosis.
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Objective:To evaluate narrow band imaging-magnifying endoscopy (NBI-ME) for the further assessment of lesions of low-grade intraepithelial neoplasia (LGIN) in the gastric biopsy.Methods:Data of 180 patients who underwent NBI-ME before endoscopic submucosal dissection (ESD) for biopsy of gastric LGIN at the First Affiliated Hospital of Soochow University from January 2017 to October 2020 were analyzed retrospectively. Taking the pathological results after ESD as the gold standard, the sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of NBI-ME in predicting the pathological upgrading of gastric LGIN lesions after ESD were calculated, and the receiver operator characteristic (ROC) curve was drawn.Results:Among 180 gastric LGIN lesions, 115 (63.89%) were pathological upgraded and 65 (36.11%) were not after ESD. There were 10 missed diagnoses, 19 misdiagnoses, and 151 correct diagnoses in NBI-ME examination before ESD. The sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of NBI-ME in predicting the pathological upgrading of gastric LGIN lesions after ESD were 91.3% (105/115), 70.8% (46/65), 84.7% (105/124), 82.1%(46/56) and 83.9% (151/180), respectively. The area under the ROC curve was 0.810 (95% CI: 0.737-0.883). Conclusion:Further NBI-ME examination of gastric LGIN lesions diagnosed by biopsy pathology can accurately predict whether the lesions have pathological upgrading after ESD, which is of important guiding significance for the patients to choose the treatment strategy of further follow-up or endoscopic resection.
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Abstract Introduction: Anal intraepithelial neoplasia (AIN) is the most likely precursor of squamous cells cancer which represents 90% of anal cancers. The use of biomolecular tests as a screening method has been extended by gynecology. Given the similarities that exist between the HPV disease in the lower genital tract and anorectal sectors, it is expected that HPV tests can provide information for the diagnosis, treatment and follow-up for AIN-affected patients. Objectives: Comparing the performance of anal cytology, PAP and HPV tests (Hybrid Capture and Papillocheck) against the histology of the diagnosis of low- and high-grade AIN in risk groups. Material and methods: A cross-sectional study was carried out to evaluate diagnostic methods for low- and high-grade AIN in 73 patients. Samples for anal PAP, Papillocheck and Hybrid Capture were taken from all patients who then, regardless of the results, underwent magnifying chromoendoscopy (MCE) along with biopsy. Diagnostic test performances and their 95% confidence intervals (CI: 95%) were calculated as well as the likelihood ratio for each test. Results: Of the 73 patients, 49 (67%) were women. The average age of the patients was 38 years. In 38 patients (52%), the histology was positive with 10 (14%) grade II AIN or higher. There were no statistically significant differences in sensitivity nor in specificity for low- and high-grade AINs between any of the tests. Conclusion: Anal PAP, the Hybrid Capture test (HC2, Qiagen) and PapilloCheck (Greiner Bio One) were highly sensitive but not specific for low- and high-grade AINs. Therefore, a biopsy should be conducted against a positive result of any of the tests to confirm AIN and the degree of dysplasia. The screening method selection depend on the availability but also costs of the test should be considered, since all the diagnostic tests have similar performance.
Resumo Introdução: A neoplasia intraepitelial anal é o precursor mais provável do câncer de células escamosas, que representa 90% dos tumores anais. O uso de exames biomoleculares como método de triagem foi ampliado pela ginecologia. Considerando-se as semelhanças entre as apresentações de HPV no trato genital inferior e anorretal, espera-se que os exames de HPV possam fornecer informações para o diagnóstico, tratamento e acompanhamento dos pacientes com neoplasia intraepitelial anal. Objetivo: Comparar o desempenho da citologia anal, Papanicolau, exames para HPV (teste de captura híbrida e Papillocheck) e histologia no diagnóstico de neoplasia intraepitelial anal de baixo e alto grau em grupos de risco. Material e métodos: Foi realizado um estudo transversal para avaliar métodos de diagnóstico de neoplasia intraepitelial anal de baixo e alto grau em 73 pacientes. Amostras para Papanicolau anal, Papillocheck e captura híbrida foram coletadas de todos os pacientes; independentemente dos resultados desses exames, todos foram submetidos a cromoendoscopia de ampliação (CEA) e biópsia. O desempenho dos exames e seus intervalos de confiança de 95% (95% CI) foram calculados, bem como a razão de verossimilhança para cada teste. Resultados: Dos 73 pacientes, 49 (67%) eram mulheres. A idade média dos pacientes foi de 38 anos. A histologia foi positiva em 38 pacientes (52%), dos quais dez (14%) apresentaram neoplasia intraepitelial anal grau II ou superior. Não foram observadas diferenças estatisticamente significativas na sensibilidade ou especificidade para as neoplasias intraepiteliais anal de baixo e alto grau entre qualquer um dos exames. Conclusão: O Papanicolau anal, o teste de captura híbrida (HC2, Qiagen) e o Papillocheck (Greiner Bio One) foram altamente sensíveis, mas não específicos para neoplasia intraepitelial anal de baixo e alto grau. Portanto, uma biópsia deve ser realizada após um resultado positivo em qualquer um dos testes para confirmar o diagnóstico de neoplasia intraepitelial anal e seu grau. A seleção do método de triagem depende da disponibilidade, mas os custos devem ser considerados, uma vez que todos os testes apresentam desempenho semelhante.
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Humans , Male , Female , Carcinoma in Situ/diagnosis , Alphapapillomavirus , Papanicolaou Test , Anus Neoplasms , Biopsy , Carcinoma in Situ/diagnostic imagingABSTRACT
Objective To compare the difference of clinical efficacy between surgical magnifying glass and surgical microscope assisted hepatic artery reconstruction in living donor liver transplantation (LDLT). Methods Clinical data of 272 donors and recipients undergoing LDLT were retrospectively analyzed. According to different patterns of hepatic artery reconstruction, all recipients were divided into the magnifying glass group (n=189) and microscope group (n=83). The operation time, intraoperative blood loss, hepatic artery reconstruction site, diameter of anastomosis, incidence of postoperative complications and survival rate of recipients were statistically compared between two groups. Results Compared with the microscope group, the operation time, hepatic artery reconstruction time and intraoperative blood loss were significantly less in the magnifying glass group (all P < 0.001). The most common site of hepatic artery reconstruction was the right hepatic artery in two groups, and the diameter of anastomosis was (2.1±0.9) mm in the magnifying glass group and (2.1±0.8) mm in the microscope group, with no statistical significance between two groups (P > 0.05). The 1-, 2- and 3-year survival rates of recipients in the magnifying glass group were 88%, 86% and 85%, which did not significantly differ from 89%, 87% and 86% in the microscope group (all P > 0.05). The incidence of postoperative complications did not significantly differ between two groups (all P > 0.05). Conclusions The efficacy and safety of hepatic artery reconstruction in LDLT under surgical magnifying glass are equivalent to those under surgical microscope, with less operation workload and intraoperative blood loss. For experienced transplantation surgeons, it is recommended to perform hepatic artery reconstruction assisted by surgical magnifying glass.
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Abstract The aim of this study was to evaluate the effect of magnification during post space preparation on root cleanness and on fiber post bond strength. Methods: Thirty human central upper incisors with similar root canal in size and shape were selected, decoronated to 15 mm and endodontically filled. The teeth were assigned into 3 groups (n=10), according to the method of magnification during post space preparation inspection: Control, using naked eye; loupe, using a dental surgical 3x magnifying glass; surgical microscope, using a 6x surgical microscope. The roots were scanned by using micro-CT before and after post space preparation for residue remnants evaluation. Fiber posts were cemented using self-adhesive resin cement (Rely X U200, 3M-ESPE). Two 1-mm-thick slices from the cervical, medium and apical thirds were submitted to a push-out test (PBS). Failures modes were classified. PBS data were analyzed by using two-way ANOVA with repeated measurement and the Tukey test. The significance level was set at 5%. The method of visualization had no effect on PBS (p=0.556). The cervical region had higher values than apical region irrespective of the inspection method (p=0.012). Adhesive failure between the resin cement and dentin was the prevalent failure mode for all groups. Micro-CT analysis showed no difference on root cleanness into the root canal after post space preparation. The use of magnification devices as loupe and microscope while performing post space do not improve the PBS and did not affect sealer remain of decoronated anterior teeth.
Resumo Avaliar o efeito do método de visualização durante o preparo do espaço do pino sobre o remanescente de material obturador endodôntico e sobre a resistência adesiva do pino de fibra de vidro. Trinta incisivos centrais superiores humanos com canal radicular circular foram selecionados, foram desobstruídos a 15 mm e obturados. Os dentes foram divididos em 3 grupos (n=10), de acordo com o método de ampliação utilizado para inspeção do preparo: Controle, usando olho nu; lupa, usando uma lupa cirúrgica 3x cirúrgica; microscópio cirúrgico, usando um microscópio cirúrgico 6x. As raízes foram digitalizadas usando micro-CT antes e após a preparação do espaço para avaliação de resíduos remanescentes. Os pinos de fibra foram cimentados com cimento resinoso autoadesivo (RelyX U200, 3M-ESPE). Duas fatias de 1 mm de espessura dos terços cervical, médio e apical foram submetidas ao teste push-out (PBS). Os padrões de falhas foram classificados. Os dados de PBS foram analisados usando análise de variância em dois fatores com medição repetida e o teste de Tukey. O nível de significância foi estabelecido em 5%. Resultados: O método de visualização não teve efeito no PBS (p=0,556). A região cervical apresentou valores maiores que a região apical, independentemente do método de inspeção (p=0,012). A falha adesiva entre o cimento resinoso e a dentina foi o modo de falha prevalente para todos os grupos. A análise de micro-CT não mostrou diferença na limpeza da raiz no canal radicular após a preparação do espaço do pino. Conclusão: O uso de dispositivos de ampliação como lupas e microscópios durante a realização de preparo não melhora o PBS e não afetou a permanência do material obturador remanescente de dentes anteriores.
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Humans , Post and Core Technique , Dental Bonding , Materials Testing , Dentin-Bonding Agents , Resin Cements , Dental Pulp Cavity , DentinABSTRACT
Objective To compare the diagnostic accuracy of magnifying chromoendoscopy (MCE) and endoscopic ultrasonography (EUS) for preoperative endoscopic assessment of the invasion depth of colorectal laterally spreading tumour(LST).Methods Data of 104 cases of colorectal LST were included.With the final pathological diagnosis as the golden standard,the accuracies of MCE and EUS for preoperative assessment of the invasion depth of colorectal LST were compared.Results The diagnostic accuracies of MCE and EUS for evaluating the invasion depth of LST were 89.4％ (93/104) and 73.1％ (76/104),respectively(P＜0.05).The lesion size and the endoscopist could affect the accuracy of the EUS evaluation (P=0.017,OR=3.561;P=0.035,OR =1.399).The accuracy of EUS seemed to show a downward trend for colorectal LST of larger diameters.Conclusion Both MCE and EUS are effective for evaluating the invasion depth of colorectal LST,but the accuracy of MCE may be higher than that of EUS.Large diameter of the lesion and the doctor's experience inadequacy may be the risk factors for the accuracy of EUS.
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Objective To investigate the effects of Helicobacter pylori (HP) radical treatment on diagnosis of early gastric cancer using conventional white light endoscopy ( WLE ) , chromoendoscopy of indigo carmine dye added to acetic acid, and magnifying endoscopy with narrow band imaging (ME-NBI). Methods Between January 2013 and March 2018, patients without HP (successful cured before six months) or with HP ( no radical treatment for HP in recent 6 months ) , who underwent endoscopy examinations in the Department of Gastroenterology of Ezhou Hospital, People's Hospital of Wuhan University or the Department of Gastroenterology of Union Hospital, Tongji Medical College Huazhong University of Science and Technology were enrolled in the study. Endoscopy examinations were performed according to the order of conventional WLE, chromoendoscopy using indigo carmine dye added to acetic acid, and ME-NBI. Among the patients finally diagnosed as early gastric cancer by histopathology, 120 patients without HP and 120 patients with HP were continuously collected, and included in the radical treatment group and the non-radical treatment group, respectively. Diagnostic reliabilities of WLE, chromoendoscopy, and ME-NBI for early gastric cancer between the two groups were statistically analyzed. Results There were no statistical differences between the two groups in terms of hospital source (χ2 =2. 637, P=0. 104) , gender composition (χ2=0. 074, P=0. 785) , mean age ( t=0. 582, P=0. 561) , and lesion morphology (χ2 = 0. 179, P= 0. 914 ) . The detection rates of early gastric cancer in the radical treatment group using WLE [ 75. 0％( 80/120 ) VS 81. 7％( 98/120 ) ,χ2 = 7. 046, P = 0. 008 ] , chromoendoscopy [ 57. 5％( 69/120 ) VS 93. 3％( 112/120 ) ,χ2 =41. 554, P<0. 001 ] , and ME-NBI [ 90. 0％( 108/120) VS 98. 3％( 118/120) ,χ2=7. 585, P=0. 006] were significantly lower than those in the non-radical treatment group. In the radical treatment group, chromoendoscopy had the lowest detection rate of early gastric cancer, followed by WLE (χ2=2. 142, P=0. 143) and ME-NBI (χ2=32. 736, P<0. 001) , while ME-NBI had the highest detection rate of early gastric cancer, which higher than that of WLE (χ2= 19.247, P<0.001). Conclusion The diagnosis of early gastric cancer by WLE, chromoendoscopy using the indigo carmine dye added to acetic acid and ME-NBI becomes more difficult after radical treatment of HP. Among the above three endoscopic methods, ME-NBI has the highest diagnostic efficacy, and becomes the first choice for the clinical diagnosis of early gastric cancer after radical treatment of HP.
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Background: Endoscopy plays an important role in the early detection of gastric neoplastic lesions, but different techniques lead to different diagnostic accuracy. Aims: To explore and compare the diagnostic value of conventional endoscopy with white light imaging (WLI) and magnifying endoscopy with narrow-band imaging (ME-NBI) for early gastric neoplastic lesions. Methods: Patients suspected of having early gastric neoplastic lesions by WLI were collected consecutively from Jan. 2016 to Jun. 2018 at Shanghai Renji Hospital, and received ME-NBI within 2 weeks. The diagnosis based on WLI and ME-NBI was recorded, respectively. Targeted biopsy was re-performed in patients with suspected neoplastic lesion yet having no abnormalities in first biopsy. Patients with neoplastic lesions proved by pathology were treated with endoscopic resection or surgical operation and enrolled in the analysis. Using pathological diagnosis as gold standard, the diagnostic performance of WLI and ME-NBI for distinguishing intestinal-type gastric adenoma and early gastric cancer (EGC) was evaluated. Results: A total of 301 patients (301 lesions) were included, including 171 adenoma and 130 EGC. The interobserver agreement between two endoscopists was optimal for both WLI and ME-NBI observation (WLI: κ=0.70; ME-NBI: κ=0.81). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ME-NBI for distinguishing intestinal-type gastric adenoma from EGC were higher than those of WLI (89.2% vs. 76.9%, 90.6% vs. 71.9%, 87.9% vs. 67.6%, 91.7% vs. 80.4%, and 90.0% vs. 74.1%, respectively, all P<0.05). Conclusions: ME-NBI is superior to WLI in distinguishing intestinal-type gastric adenoma from EGC.
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Background: Esophageal basaloid squamous cell carcinoma (BSCC) is a rare variant of squamous cell carcinoma characterized by aggressive biological behavior and poor prognosis. Curative resection at early stage can significantly improve the outcome of patients with esophageal BSCC. Endoscopic biopsy is the main approach for the diagnosis of early esophageal cancer, however, the endoscopic features of early esophageal BSCC have not yet been systematically studied. Aims: To summarize the endoscopic features of early esophageal BSCC. Methods: The clinical, endoscopic and pathological data of 5 cases of early esophageal BSCC confirmed by pathology of endoscopic submucosal dissection from June 2016 to March 2019 at the Affiliated Drum Tower Hospital of Nanjing University Medical School were retrospectively analyzed. Results: The patients were 5 males with a mean age of 61 years old. Most of the lesions were located in the middle thoracic esophagus (3/5); the long diameter was equal to or more than 3 cm (4/5), and near 50% circumference of the esophagus was involved (5/5). All of the 5 lesions were presented as endoscopic type Ⅱb. Most of the lesions showed only mucosal roughness under white light endoscopy and there were no obvious demarcation or background color changes under narrow-band imaging. Intrapapillary capillary loop (IPCL) was categorized as type B1 with low density under magnifying endoscopy in four cases. Iodine staining revealed less-stained or no staining in all the cases. Postoperative pathological results showed T1a tumor in all the cases. Conclusions: The endoscopic findings of early esophageal BSCC were occult. Most of the cases only show rough and flat lesion without other obvious specific changes. Type B1 microvessels with a low density under magnifying endoscopy might be a characteristic feature of early esophageal BSCC.
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Objective@#To evaluate optical coherence tomography(OCT)for predicting invasion depth of early esophageal cancer(EEC) and to compare OCT and magnifying endoscopy-narrow band imaging (ME-NBI)in clinical performance.@*Methods@#Twenty-eight patients who were diagnosed with EEC and accepted OCT and ME-NBI before endoscopic submucosal dissection(ESD)were enrolled in this prospective study. On the basis of OCT and ME-NBI images, real-time prediction of EEC invasion depth was conducted. Postoperative pathological results were taken as golden standard to compare the accuracy of OCT and ME-NBI in evaluation of EEC invasion depth. The procedure time and incidence of complications during evaluation process were also analyzed.@*Results@#The overall accuracy of OCT and ME-NBI in predicting invasion depth of 28 EEC patients were 67.9% (19/28) and 75.0% (21/28) respectively, with no significant difference(P>0.05). The accuracy of OCT and ME-NBI in distinguishing lesions located in epithelium/lamina propria mucosa (EP/LPM) lesions were 78.9%(15/19) and 68.4% (13/19), with no significant difference(P>0.05). The procedure time of OCT was significantly shorter than that of ME-NBI (6.0±2.9 min VS 16.3±5.4 min, P<0.001).@*Conclusion@#The ability of OCT to predict invasion depth of EEC and distinguish lesions located in the EP/LPM is comparable with that of ME-NBI. Besides, OCT requires shorter procedure time for evaluation.
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Objective@#To investigate the effects of Helicobacter pylori (HP) radical treatment on diagnosis of early gastric cancer using conventional white light endoscopy (WLE), chromoendoscopy of indigo carmine dye added to acetic acid, and magnifying endoscopy with narrow band imaging (ME-NBI).@*Methods@#Between January 2013 and March 2018, patients without HP (successful cured before six months) or with HP (no radical treatment for HP in recent 6 months), who underwent endoscopy examinations in the Department of Gastroenterology of Ezhou Hospital, People′s Hospital of Wuhan University or the Department of Gastroenterology of Union Hospital, Tongji Medical College Huazhong University of Science and Technology were enrolled in the study. Endoscopy examinations were performed according to the order of conventional WLE, chromoendoscopy using indigo carmine dye added to acetic acid, and ME-NBI. Among the patients finally diagnosed as early gastric cancer by histopathology, 120 patients without HP and 120 patients with HP were continuously collected, and included in the radical treatment group and the non-radical treatment group, respectively. Diagnostic reliabilities of WLE, chromoendoscopy, and ME-NBI for early gastric cancer between the two groups were statistically analyzed.@*Results@#There were no statistical differences between the two groups in terms of hospital source (χ2=2.637, P=0.104), gender composition (χ2=0.074, P=0.785), mean age (t=0.582, P=0.561), and lesion morphology (χ2=0.179, P=0.914). The detection rates of early gastric cancer in the radical treatment group using WLE [75.0% (80/120) VS 81.7% (98/120), χ2=7.046, P=0.008], chromoendoscopy [57.5% (69/120) VS 93.3% (112/120), χ2=41.554, P<0.001], and ME-NBI [90.0% (108/120) VS 98.3% (118/120), χ2=7.585, P=0.006] were significantly lower than those in the non-radical treatment group. In the radical treatment group, chromoendoscopy had the lowest detection rate of early gastric cancer, followed by WLE (χ2=2.142, P=0.143) and ME-NBI (χ2=32.736, P<0.001), while ME-NBI had the highest detection rate of early gastric cancer, which higher than that of WLE (χ2= 19.247, P<0.001).@*Conclusion@#The diagnosis of early gastric cancer by WLE, chromoendoscopy using the indigo carmine dye added to acetic acid and ME-NBI becomes more difficult after radical treatment of HP. Among the above three endoscopic methods, ME-NBI has the highest diagnostic efficacy, and becomes the first choice for the clinical diagnosis of early gastric cancer after radical treatment of HP.
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Objective To investigate the clinical utility of magnifying endoscopy combined with nar-row-band imaging( ME-NBI)and endoscopic ultrasonography( EUS)in predicting the depth of early eso-phageal cancer. Methods Sixty-eight patients with early esophageal cancer after gastroscopic and pathological diagnosis were enrolled in Jiangsu Provincal Hospital of Traditional Chinese Medicine from January 2017 to May 2018,ME-NBI and EUS were performed preoperatively to determine the depth of lesion infiltration respectively, the accuracies of the two methods were calculated by referring to the postoperative pathology,and the McNemar test and Kappa test were used for comparison. Results The lesion confined to shallow mucosa and submucosa superficial layer was confirmed in 57 patients by postoperative pathology,submucosa superficial below in 11 pa-tients. Compared with that of histology,the ability of assessment of the invasion depth was moderately consistent with ME-NBI(McNemar test P = 0. 508;Kappa = 0. 560,P < 0. 001),not with EUS(McNemar test P =0. 019;Kappa = 0. 266,P = 0. 015). The accuracy for assessing invasion depth of early esophageal cancer was 86. 8％(59 / 68)by ME-NBI,72. 1％(49 / 68)by EUS,respectively,with statistically significant difference (McNemar test P = 0. 015;Kappa = 0. 258,P = 0. 026). Conclusion ME-NBI and EUS can help to deter-mine the infiltration level of early esophageal cancer. The accuracy of ME-NBI is higher,which is of high value for the formulation of surgical plans for patients.
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There have been many advances in endoscopic imaging technologies. Magnifying endoscopy with narrow-band imaging is an innovative optical technology that enables the precise discrimination of structural changes on the mucosal surface. Several studies have demonstrated its usefulness and superiority for tumor detection and differential diagnosis in the stomach as compared with conventional endoscopy. Furthermore, magnifying endoscopy with narrow-band imaging has the potential to predict the invasion depth and tumor margins during gastric endoscopic submucosal dissection. Classifications of the findings of magnifying endoscopy with narrow-band imaging based on microvascular and pit patterns have been proposed and have shown excellent correlations with invasion depth confirmed by microscopy. In terms of tumor margin prediction, magnifying endoscopy with narrow-band imaging offers superior delineation of gastric tumor margins compared with traditional chromoendoscopy with indigo carmine. The limitations of narrow-band imaging, such as the need for considerable training, long procedure time, and lack of studies about its usefulness in undifferentiated cancer, should be resolved to confirm its value as a complementary method to endoscopic submucosal dissection. However, the role of magnifying endoscopy with narrow-band imaging is expected to increase steadily with the increasing use of endoscopic submucosal dissection for the treatment of gastric tumors.
Subject(s)
Classification , Diagnosis, Differential , Discrimination, Psychological , Endoscopy , Indigo Carmine , Methods , Microscopy , Narrow Band Imaging , StomachABSTRACT
Objective To investigate the diagnostic value of endoscopic ultrasonography combined with magnifying endoscopy with narrow band imaging (NBI-ME) in the diagnosis of early colorectal cancer.Methods A total of 187 patients with early colorectal cancer who were treated in Cancer Hospital Chinese Academy Medical Sciences and Peking Union Medical College from January 2015 to December 2017 were retrospectively analyzed.The patients were examined with NBI-ME along with endoscopic ultrasonography before endoscopic or surgical treatment,and the depth of invasion was judged.Finally,postoperative pathology was taken as the gold standard to evaluate the value of endoscopic ultrasonography combined with NBI-ME in the diagnosis of early colorectal cancer.Results The histopathological results were treated as the golden standard.The diagnostic accuracy rate of endoscopic ultrasonography and endoscopic ultrasonography combined with NBI-ME in 187 patients with early colorectal cancer was 84.0 ％ (157/187),92.5 ％ (173/187)respectively.Overall accuracy rate of the invasive depth of NBI-ME in the patients with early colorectal cancer was 87.2 ％ (166/187).Sensitivity of endoscopic ultrasonography combined with NBI-ME to Tm,Tsml and ≥Tsm2 in early colorectal cancer pathological tissues was 92.4 ％,90.4 ％,93.3 ％ respectively,and the corresponding specificity was 93.9 ％,90.1％,90.9 ％ respectively.The diagnostic accuracy rate of endoscopic ultrasonography combined with NBI-ME was higher than that of endoscopic ultrasonography,and there was a significant difference (x2 =6.594,P =0.010 2).Conclusion Endoscopic ultrasonography combined with NBI-ME has a high accuracy rate for evaluating the depth of invasion in early colorectal cancer,which contributes to a good application value for preoperative evaluation of early colorectal cancer.
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Objective To evaluate the clinical value of acetic acid with narrow-band imaging ( NBI ) and magnifying endoscopy ( ME ) on diagnosis of small colorectal polyps. Methods In this prospective study, 261 small colorectal polyps from 122 patients were observed by ME, NBI-ME, and acetic acid with NBI-ME, and then received endoscopic treatment. Endoscopic images were stored electronically and randomly allocated to 3 experts and 3 non-experts for diagnosis using Kudo pit pattern. The postoperative pathologic results acted as gold standard to evaluate the diagnostic accuracy of different endoscopic modes for small colorectal polyps. The image definition and interobserver agreement were compared among different endoscopic modes. Results The diagnostic accuracy of ME, NBI-ME, and acetic acid with NBI-ME for small colorectal polyps was 65. 5％ ( 171/261) , 90. 0％ ( 235/261) , and 94. 6％ ( 247/261) , respectively, in the experts group, and 57. 1％ ( 149/261) , 83. 1％ ( 217/261) , and 89. 3％ ( 233/261) , respectively, in the non-experts group. All experts and non-experts diagnosed small colorectal polyps more accurately by acetic acid with NBI-ME than by NBI-ME ( all P<0. 05 ) and ME ( all P<0. 001 ) . The image definition scores of acetic acid with NBI-ME in the experts group and non-experts group were significantly higher than those of NBI-ME and ME ( all P<0. 001) . The results of interobserver agreement showed that Kappa values (95％CI) of ME, NBI-ME, and acetic acid with NBI-ME diagnosis were 0. 578 (0. 508-0. 648), 0. 669 (0. 599-0. 739), and 0. 940 (0. 870-1. 010), respectively, for experts and 0. 476 (0. 406-0. 546), 0. 534 ( 0. 464-0. 604) , and 0. 830 ( 0. 760-0. 900 ) , respectively, for non-experts. Acetic acid with NBI-ME showed good interobserver agreement. Conclusion Acetic acid with NBI-ME has a higher diagnostic accuracy and good reproducibility for colorectal small polyps compared with ME and NBI-ME.
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Objective To evaluate the diagnostic value of VS classification of magnifying endoscopy with blue laser imaging ( ME-BLI) for gastric precancerous lesion and early gastric cancer. Methods A retrospective study was performed on the data of 313 patients ( 322 lesions) with gastric mucosal lesions undergoing ME-BLI in digestive endoscopy center of Renmin Hospital of Wuhan University from January 2014 to January 2017. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of VS classification by ME-BLI in diagnosis of gastric precancerous lesion and early cancer were analyzed. Results Among the 322 lesions, 57 were pathologically diagnosed as cancerous lesions and 265 were non-cancerous lesions. According to VS classification of ME-BLI, 98. 2%(56/57) VS structures of the cancerous lesions were irregular or disappearing, and 100. 0%( 57/57 ) cancerous lesions had clear demarcation. Taking the pathological diagnosis as the gold standard, the accuracy of VS classification of ME-BLI was 93. 8%(302/322), with a good consistency with pathological diagnosis(Kappa＝0. 810). The sensitivity, specificity, positive predictive value, and negative predictive value were 98. 2%( 56/57), 92. 8%( 246/265 ), 74. 7%( 56/75 ) and 99. 6%( 246/247 ), respectively. Conclusion The VS classification of ME-BLI is an effective method with high accuracy, sensitivity and specificity for diagnosis of gastric precancerous lesion and early gastric cancer.