Diagnostic value of high-resolution micro-endoscopy for the classification of colon polyps.

AIM: To study a new imaging equipment, high-resolution micro-endoscopy (HRME), in the diagnosis and pathological classification of colon polyps. METHODS: We selected 114 specimens of colon polyps, 30 of which were colon polyps with known pathological types and 84 that were prospective polyp specimens; 10 normal colon mucosa specimens served as controls. We obtained images of 30 colon polyp specimens with known pathological types using HRME and analyzed the characteristics of these images to develop HRME diagnostic criteria for different pathological types of colon polyps. Based on these criteria, we performed a prospective study of 84 colon polyp specimens using HRME and compared the results with those of the pathological examination to evaluate the diagnostic value of HRME in the pathological classification of different types of colon polyps. RESULTS: In the 30 cases of known pathological type of colon polyp samples, there were 21 cases of adenomatous polyps, which comprised nine cases of tubular adenoma, seven cases of villous adenoma and five cases of mixed adenomas. The nine cases of non-adenomatous polyps included four cases of inflammatory polyps and five cases of hyperplastic polyps five. Ten cases of normal colonic mucosa were confirmed pathologically. In a prospective study of 84 cases using HRME, 23 cases were diagnosed as inflammatory polyps, 11 cases as hyperplastic polyps, 18 cases as tubular adenoma, eight cases as villous adenoma and 24 cases as mixed adenomas. After pathological examination, 24 cases were diagnosed as inflammatory polyps, 11 cases as hyperplastic polyps, 19 cases as tubular adenoma, eight cases as villous adenoma and 22 cases as mixed adenomas. Compared with the pathological examinations, the sensitivities, specificities, accuracies, and positive and negative predictive values of HRME in diagnosing inflammatory polyps (87.5%, 96.7%, 94.0%, 91.3% and 95.1%), hyperplastic polyps (72.7%, 95.9%, 92.9%, 72.7% and 95.9%), tubular adenomas (73.7%, 93.8%, 89.3%, 77.8% and 92.4%), villous adenomas (75.0%, 97.4%, 95.2%, 75.0% and 97.4%), and mixed adenomas (75.0%, 93.3%, 88.1%, 81.8% and 90.3%) were relatively high. CONCLUSION: HRME has a relatively high diagnostic value in the pathological classification of colon polyps. Thus, it may be an alternative to confocal microendoscopy in lower-resource or community-based settings.

High resolution micro-endoscopy for digestive tract normal mucosa / 中国内镜杂志

Objective To summarize the picture features of high resolution micro-endoscopy (HRME) for normal gastrointestinal mucosa. Methods We select 10 cases' normal esophageal mucosa, gastric and duodenal mucosa, in-testinal mucosa and colonic mucosal biopsies for this study, use HRME to observe the specimens and describe the features of different parts of the digestive tract normal mucosa according to the collected HRME pictures. Results After HRME imaging, all specimens were sent to pathological examination. We obtained 1 284 HRME pictures for 50 cases of biopsy specimens, 400 pictures were selected for results analysis after screening. HRME image charac-teristics of different parts of the digestive tract normal mucosa are as follows. Esophageal mucosa: cell arrangement rules, round and bright nucleus, the same size, nuclear spacing normal, the number of cells per field in basically are the same. Fundic mucosa: numerous closely arranged glands as well as oval or elongated branched openings of the gastric pits and linear peripheral cracks were visible; the nuclei were arranged regularly. Antral mucosa: irregular or tubular openings of the gastric pits and cracked glandular cavities were visible, with the cells surrounding the gastric pits regularly arranged and the nuclei small and densely distributed. Duodenal mucosa:visible villi was large fingers,on both sides of lint jagged depression, stereoscopic obviously, a cluster-like arrangement and the gap was crack-like. Intestinal mucosa:villous structures wider gap is wider, less than the number of the duodenum. Colonic mucosa:the nucleus of the same size, shape rules, round or oval and daisy-like glandular structures. All specimens were confirmed normal mucosa by pathology. Conclusion HRME can accurately identify the different parts of the diges-tive tract normal mucosa and it has a high consistency compared with pathological results.

Feasibility of high resolution micro-endoscopy for diagnosis of gastric cancer / 中华消化内镜杂志

Objective To explore the feasibility of high?resolution micro?endoscopy for diagnosis of gastric cancer. Methods A retrospective analysis of HRME pictures of gross specimen of gastric carcinoma of 20 cases of gastric cancer and normal gastric mucosa was made. Picture characteristics were studied and the HRME diagnostic criteria for normal gastric mucosa and gastric cancer tissues were developed. Based on the diagnostic criteria, a prospective study on gastric biopsy specimens of 64 cases of suspected gastric carci?noma was conducted and the diagnostic value of HRME for gastric carcinoma was evaluated by comparing HRME pre?diagnostic results with pathological findings. Results In the superficial layer of the fundic muco?sa, numerous regularly branched arranged glands as well as oval or elongated openings of the gastric pits and linear peripheral cracks were visible;the nuclei were arranged regularly. In the superficial layer of the antral mucosa, irregular or tubular openings of the gastric pits and cracked glandular cavities were visible, with the cells surrounding the gastric pits regularly arranged and the nuclei small and densely distributed. In the gas?tric carcinoma, nuclei sizes were different, arranged messy. Gland sizes were various, with unclear structure or glandular structures that could not be observed. Structure of gastric pits was damaged and normal gastric pits disappeared. After HRME imaging was performed on 64 cases of gastric biopsy specimens, the sensitivi?ty, specificity, accuracy, negative predictive value and positive predictive value of HRME diagnosis of gastric carcinoma were 96?4%( 53/55 ) , 88?9%( 8/9 ) , 95?3%( 61/64 ) , 98?1%( 53/54 ) and 80?0%( 8/10) respectively. Conclusion HRME, a new and instant pathological imaging tool with low price and simple operation, can distinguish normal gastric mucosa and gastric cancer tissue clearly, with a high diagno?sis value for gastric cancer.