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Abstract：
OBJECTIVE: The diagnostic accuracy of Narrow Band Imaging (NBI) in the endoscopic surveillance of ulcerative colitis (UC) has been disappointing in most trials which used the Kudo classification. We aim to compare the performance of NBI in the lesion characterization of UC, when applied according to three different classifications (NICE, Kudo, Kudo-IBD).
METHODS: In a prospective, real-life study, all visible lesions found during consecutive surveillance colonoscopies with NBI (Exera-II CV-180) for UC were classified as suspected or non-suspected for neoplasia according to the NICE, Kudo and Kudo-IBD criteria. The sensitivity (SE), specificity (SP), positive (+LR) and negative (-LR) likelihood ratios of the three classifications were calculated, using histology as the reference standard.
RESULTS: 394 lesions (mean size 6 mm, range 2-40 mm) from 84 patients were analysed. Twenty-one neoplastic (5%), 49 hyperplastic (12%), and 324 inflammatory (82%) lesions were found. The diagnostic accuracy of the NICE, Kudo and Kudo-IBD classifications were, respectively: SE 76%-71%-86%; SP 55-69%-79% (p < 0.05 Kudo-IBD vs. both Kudo and NICE); +LR 1.69-2.34-4.15 (p < 0.05 Kudo-IBD vs. both Kudo and NICE); -LR 0.43-0.41-0.18.
CONCLUSIONS: The diagnostic accuracy of NBI in the differentiation of neoplastic and non-neoplastic lesions in UC is low if used with conventional classifications of the general population, but it is significantly better with the modified Kudo classification specific for UC.
METHODS: In a prospective, real-life study, all visible lesions found during consecutive surveillance colonoscopies with NBI (Exera-II CV-180) for UC were classified as suspected or non-suspected for neoplasia according to the NICE, Kudo and Kudo-IBD criteria. The sensitivity (SE), specificity (SP), positive (+LR) and negative (-LR) likelihood ratios of the three classifications were calculated, using histology as the reference standard.
RESULTS: 394 lesions (mean size 6 mm, range 2-40 mm) from 84 patients were analysed. Twenty-one neoplastic (5%), 49 hyperplastic (12%), and 324 inflammatory (82%) lesions were found. The diagnostic accuracy of the NICE, Kudo and Kudo-IBD classifications were, respectively: SE 76%-71%-86%; SP 55-69%-79% (p < 0.05 Kudo-IBD vs. both Kudo and NICE); +LR 1.69-2.34-4.15 (p < 0.05 Kudo-IBD vs. both Kudo and NICE); -LR 0.43-0.41-0.18.
CONCLUSIONS: The diagnostic accuracy of NBI in the differentiation of neoplastic and non-neoplastic lesions in UC is low if used with conventional classifications of the general population, but it is significantly better with the modified Kudo classification specific for UC.
摘要：
目的：在大多数使用Kudo分类的试验中，窄带成像（NBI）在溃疡性结肠炎（UC）的内镜监测中的诊断准确性令人失望。我们的目的是比较NBI在UC病变表征中的表现，当根据三种不同的分类应用时(NICE，Kudo,Kudo-IBD）。
方法：在前瞻性中，现实生活中的研究，根据NICE,在使用NBI(Exera-IICV-180)对UC进行连续监测结肠镜检查期间发现的所有可见病变均被分类为疑似或非疑似瘤形成,Kudo和Kudo-IBD标准。灵敏度（SE），特异性（SP），计算三个分类的正(+LR)和负(-LR)似然比，使用组织学作为参考标准。
结果：394个病灶（平均大小6毫米，范围2-40毫米）对84例患者进行了分析。21个肿瘤（5%），49例增生（12%），发现了324个炎症（82％）病变。NICE的诊断准确性，Kudo和Kudo-IBD分类是，分别为：SE76%-71%-86%；SP55-69%-79%(p<0.05Kudo-IBDvs.Kudo和NICE）；+LR1.69-2.34-4.15（p<0.05Kudo-IBDvs.工藤和NICE）；-LR0.43-0.41-0.18。
结论：如果与普通人群的常规分类一起使用，NBI在UC肿瘤和非肿瘤性病变的鉴别中的诊断准确性较低，但改良后的UC特异性Kudo分类明显更好。
方法：在前瞻性中，现实生活中的研究，根据NICE,在使用NBI(Exera-IICV-180)对UC进行连续监测结肠镜检查期间发现的所有可见病变均被分类为疑似或非疑似瘤形成,Kudo和Kudo-IBD标准。灵敏度（SE），特异性（SP），计算三个分类的正(+LR)和负(-LR)似然比，使用组织学作为参考标准。
结果：394个病灶（平均大小6毫米，范围2-40毫米）对84例患者进行了分析。21个肿瘤（5%），49例增生（12%），发现了324个炎症（82％）病变。NICE的诊断准确性，Kudo和Kudo-IBD分类是，分别为：SE76%-71%-86%；SP55-69%-79%(p<0.05Kudo-IBDvs.Kudo和NICE）；+LR1.69-2.34-4.15（p<0.05Kudo-IBDvs.工藤和NICE）；-LR0.43-0.41-0.18。
结论：如果与普通人群的常规分类一起使用，NBI在UC肿瘤和非肿瘤性病变的鉴别中的诊断准确性较低，但改良后的UC特异性Kudo分类明显更好。
