应用JNET分型非实时诊断结直肠病变的的临床价值研究
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1.上海交通大学医学院附属仁济医院消化内科;2.上海交通大学医学院附属仁济医院消化内科 上海市消化疾病研究所200001;3.上海交通大学医学院附属仁济医院消化内镜中心

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The clinical value of non-real-time diagnosis of colorectal lesions with JNET classificationS
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    【】 目的 探究应用JNET(Japan NBI Expert Team)分型区分结直肠息肉性质的临床价值 方法 回顾性观察418处结直肠病变在放大内镜窄带成像技术(magnifying endoscopy with narrow band imaging,ME-NBI)下的清晰图像,由两位缺乏放大内镜使用经验的医生,在短程JNET分型诊断标准培训后作出相应诊断,并与切除的病理结果进行对比分析。 结果 依据ME-NBI下JNET分型区分肿瘤性病变的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为98.2%、77.8%、98.5%、75%、96.9%;区分癌性病变的上述指标分别为66.7%、87.6%、66.1%、87.9%、82.1%;区分黏膜下深层浸润癌分别为34.8%、100.0%、100.0%、96.3、96.4%。按病变大小0-9mm、10-19mm、≥20mm进行分类,三者分别对应的JNET分型诊断肿瘤性病变的准确性分别为95.2%、97.0%、97.8%,无显著差异(P=0.483);诊断癌性病变的准确性分别为95.2%、85.1%、72.1%,差异显著(P<0.0001);诊断深层浸润癌的准确性分别为100%、96.3%、94.4%,差异显著(P=0.026)。此外,形态、大小对JNET分型诊断病变性质的准确性无显著影响。结论 缺乏放大内镜使用经验的医生经短程培训后应用JNET分型可较准确作出结直肠病变的非实时诊断,但对于2cm及以上息肉癌性病变的诊断准确性还有待提高。

    Abstract:

    Objective To evaluate the diagnostic ability of differentiating pathological nature of the Japan NBI Expert Team (JNET) classification. Methods 418 lessions were retrospectively diagnosed by JNET classification through observing the microvessle and surface structure under magnifying endoscopy with NBI by two doctors with no experence of using magnifying endoscopy. The results were then compared with actual histologic findings.Results With ME-NBI JNET classification the sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and accuracy which for differentiating neoplastic change was 98.2%,77.8%,98.5%,75%,96.9% respectively,which for diagnosing cancer which includes High grade intraepithelial neoplasiae/Intramucosal carcinoma and submucosal carcinoma was 66.7%,87.6%,66.1%,87.9%,82.1% respectively,and which for predicting submucosal deep invasive cancer was 34.8%,100%,100%,96.3,96.4%.The diagnostic accuracy which for cancer was 95.2% in 0-9mm group,85.1% in 10-19mm group , 72.1% in more than 20mm group and which for submucosal deep invasive cancer was 100%,96.3%,94.4%,respectively in each group. Both of them emerged significant difference with P <0.05.Otherwise,the shape and location of colorectal lessions have no significant effect on the diagnostic ability of JNET classification. Conclusion JNET classicfication is valuable for doctors with no experence of ME-NBI in diagnosing colorectal lessions afer a short time training.However, for big polyps especially two centimeters or more ,the accurancy of diagnosing cancer need to be improved.

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周菁,章庆伟,黄戬,等.应用JNET分型非实时诊断结直肠病变的的临床价值研究[J].中华消化内镜杂志,2019,36(5):328-333.

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  • 收稿日期:2018-01-24
  • 最后修改日期:2019-01-30
  • 录用日期:2018-03-13
  • 在线发布日期: 2019-05-28
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