摘要
目的大肠腺管开口形态(pitpattern)的工藤分类是公认的放大色素内镜诊断标准。pitpattern诊断正确与否将影响对内镜所见病变的诊断及处置,本文目的是对其鉴别诊断能力进行评价。方法对一组放大色素内镜图像的pit pattern按工藤分类进行诊断,并根据pit pattern预测其临床诊断为非肿瘤或肿瘤性病变,以Kappa分析计算pit pattern诊断及预测临床诊断的观察者间差异。结果根据pitpattern预测临床诊断非肿瘤和肿瘤性病变的诊断一致百分率分别为80.8%和92.1%,观察者间一致性(kappa平均值=0.733)显著高于pit pattern诊断本身的一致性(P=0.015)。由于Ⅱ型和ⅢL型之间的鉴别诊断差异所导致的诊断差异占全部预测临床诊断差异的72.2%。结论根据pit pattern作出非肿瘤或肿瘤性病变的预测临床诊断时,观察者间一致性显著提高。但有一部分肿瘤性病变会被误诊为非肿瘤病变,因此在放大色素内镜检查时需注意鉴别诊断,特别是Ⅱ型与ⅢL型的鉴别,并应与其他检查手段相配合以明确临床诊断。
Objective Kudo＇s classification of colonic pit patterns has been recognized as the diagnostic criteria of magnifying chromoendoscopy. Validity of the pit pattern diagnosis affects the endoscopic diagnosis and management of colonic lesions. Thus, analysis of differential diagnosis of pit patterns was performed in this study. Methods Pit patterns of a set of magnifying chromoendoscopic images were diagnosed according to Kudo＇s classification, and clinical diagnosis of non-neoplasm or neoplastic lesion was predicted according to the pit pattern diagnosis. Interobserver agreement was calculated using Kappa statistics. Percentage agreement of each pit pattern and the predicted clinical diagnosis was calculated to analyze the discrepancy of the diagnoses. Results Percentage agreement of the predicted clinical diagnosis of non-neoplasm and neoplastic lesion was 80.8% and 92.1%, respectively, and the interobserver agreement （mean kappa = 0.733） was significantly more consistent than the pit pattern diagnosis （P = 0.015）. Difference in the diagnosis between type Ⅱ and type ⅢL accounted for most of the discrepancy （72.2%） of the predicted clinical diagnosis. Conclusion Interobserver agreement of the predicted clinical diagnosis of non-neoplasm or neoplastic lesion is significantly more consistent. However, some neoplastic lesions may be misdiagnosed as non-neoplasm, and differential diagno- sis in magnifying chromoendoscopy is essential, especially between type Ⅱ and type Ⅲ L, which needs to combine with other diagnostic measures to determine the clinical diagnosis.
出处
《现代消化及介入诊疗》
2009年第2期67-70,共4页
Modern Interventional Diagnosis and Treatment in Gastroenterology
基金
解放军总医院苗圃基金资助项目(07MP05)
关键词
大肠腺管开口形态
放大色素内镜
鉴别诊断
Colonic pit pattern
Magnifying chromoendoscopy
Differential diagnosis
