Randomised controlled trial comparing modified Sano’s and narrow band imaging international colorectal endoscopic classifications for colorectal lesions

• 作者: Amanda Ovenden Andrew Ruszkiewicz Doreen Siew Ching Koay James Y Lau Kuan Loong Cheong Leonardo Zorrón Cheng Tao Pu Mahima Raju Philip W Chiu Rajvinder Singh Sze Pheh Yeap
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: COLORECTAL POLYPS COLORECTAL ADENOMAS COLORECTAL NEOPLASM COLORECTAL lesions RANDOMISED controlled trial COLONOSCOPY Magnifying COLONOSCOPY Endoscopic imaging
• 年，卷（期）: 2018,（9）
• 页码范围: 210-218
• 页数: 9页
• 分类号: R765.41

摘要

AIM To assess the utility of modified Sano′s(MS)vs thenarrow band imaging international colorectal endoscopic(NICE)classification in differentiating colorectal polyps.METHODS Patients undergoing colonoscopy between 2013 and 2015 were enrolled in this trial.Based on the MS or the NICE classifications,patients were randomised for real-time endoscopic diagnosis.This was followed by biopsies,endoscopic or surgical resection.The endoscopic diagnosis was then compared to the final(blinded)histopathology.The primary endpoint was the sensitivity(Sn),specificity(Sp),positive predictive value(PPV)and negative predictive value(NPV)of differentiating neoplastic and non-neoplastic polyps(MSⅡ/Ⅱo/Ⅲa/Ⅲb vs I or NICE 1 vs 2/3).The secondary endpoints were“endoscopic resectability”(MSⅡ/Ⅱo/Ⅲa vsⅠ/Ⅲb or NICE 2 vs 1/3),NPV for diminutive distal adenomas and prediction of post-polypectomy surveillance intervals.RESULTS A total of 348 patients were evaluated.The Sn,Sp,PPV and NPV in differentiating neoplastic polyps from non-neoplastic polyps were,98.9%,85.7%,98.2%and 90.9%for MS;and 99.1%,57.7%,95.4%and 88.2%for NICE,respectively.The area under the receiver operating characteristic curve(AUC)for MS was 0.92(95%CI:0.86-0.98);and AUC for NICE was 0.78(95%CI:0.69,0.88).The Sn,Sp,PPV and NPV in predicting“endoscopic resectability”were 98.9%,86.1%,97.8%and 92.5%for MS;and 98.6%,66.7%,94.7%and 88.9%for NICE,respectively.The AUC for MS was 0.92(95%CI:0.87-0.98);and the AUC for NICE was 0.83(95%CI:0.75-0.90).The AUC values were statistically different for both comparisons(P=0.0165 and P=0.0420,respectively).The accuracy for diagnosis of sessile serrated adenoma/polyp(SSA/P)with high confidence utilizing MS classification was 93.2%.The differentiation of SSA/P from other lesions achieved Sp,Sn,PPV and NPV of 87.2%,91.5%,89.6%and 98.6%,respectively.The NPV for predicting adenomas in diminutive rectosigmoid polyps(n=150)was 96.6%and 95%with MS and NICE respectively.The calculated accuracy of post-polypectomy surveilla