The Clinical Value Of Endoscopic Blue Laser Imaging In The Diagnosis Of Colorectal Neoplasm By NICE Classification And JNET Classification

【Background】In recent years,the incidence and mortality of colorectal cancer in China have increased year by year,and most colorectal cancers are derived from colorectal adenomatous polyps.When classified histopathologically,colorectal polyps can be divided into adenomatous polyps and non adenomatous polyps(including hyperplastic polyps,inflammatory polyps,juvenile polyps,etc.),with adenomatous polyps being the most common clinically and colorectal adenomas considered to be important precancerous lesions of colorectal cancer.Multiple studies at home and abroad have confirmed that timely removal of colorectal adenomatous polyps can significantly reduce the risk of colorectal cancer,so early detection and timely removal of colorectal polyps is an effective measure for secondary prevention of colorectal cancer.Image enhanced endoscopy has obvious advantages in the identification of neoplastic and non neoplastic polyps,especially magnification endoscopy,and in recent years blue laser imaging,a novel image-enhanced technique,has also begun to be used in the clinic,and relevant studies have shown that it is as good as narrow-band imaging in diagnosing the nature of colorectal lesions and the depth of invasion.【Objective】To evaluate and compare the clinical value of the narrow band imaging international colorectal endoscopic classification and the Japan Narrow-Band Imaging Expert Team classification for the diagnosis of colorectal neoplasms based on endoscopic blue laser imaging..【Methods】A total of 130 consecutive colorectal polyps detected by the same doctor in the Department of digestive endoscopy of the second people’s Hospital of Longgang District,Shenzhen from January 2018 to December 2018 were collected and classified by NICE classification and JNET classification.The pathological results of endoscopic resection specimens were comparatively analyzed,and the overall sensitivity,specificity,positive predictive value,and negative predictive value of the two classifications were calculated.And accuracy rate and were compared,the measurement data were statistically analyzed,using chi square test,the difference was statistically significant when P<0.05.【Results】Of 130 polyps,51 were classified as type 1,79 as type 2 according to NICE classification;46 as type 1,84 as type 2 according to JNET classification,37 were non-tumorous polyps and 93 were tumorous polyps.The overall sensitivity,specificity,positive predictive value,negative predictive value and accuracy of NICE Classification for colorectal neoplasm were 79.6%,86.5%,93.7%,62.7%and 81.5%respectively.The overall sensitivity,specificity,positive predictive value,negative predictive value and accuracy of JNET Classification for colorectal neoplasm were89.2%,97.3%,98.8%,78.3%and 91.5%respectively.The difference in accuracy between NICE Classification and JNET Classification was statistically significant(c~2=5.58,P<0.05).The overall sensitivity,specificity and accuracy of 92 polyps with diameter≤5mm were 67.8%,87.9%,and 75.0%,respectively,according to NICE classification,and 84.7%,97%,and 89.1%,respectively,according to JNET classification,the difference in accuracy between the two classification was statistically significant(c~2=6.24,P=0.012).There was no significant difference in sensitivity,specificity and accuracy between NICE classification and JNET classification in the diagnosis of 38 polyps with diameter>5mm(P>0.05).Among 80flat polyps,the accuracy of JNET classification in diagnosing neoplastic lesions(90.0%)was significantly improved compared with the accuracy of NICE Classification(76.3%)(c~2=5.39,P=0.020).【Conclusion】JNET classification with blue laser imaging endoscopy is better than that of NICE classification in the diagnosis of colorectal neoplasm,and its main advantage lies in diminutive polyps and flat polyps.