Diagnostic Value Of Magnifying Endoscopy With Blue Laser Imaging For Colorectal Neoplastic Lesions

Objective: To evaluate the clinical value of Japanese NBI expert team(JNET)classification in the differential diagnosis of colorectal neoplastic lesions under magnifying endoscopy with blue laser imaging,and the clinical significance of Kudo’s pit pattern classification in improving the accuracy of JNET type 2B in predicting pathological diagnosis,so as to better select treatment modalities.Methodology: This study included 185 patients who underwent colonoscopy and found neoplastic lesions in Shengjing Hospital Affiliated to China Medical University from November 2021 to December 2022.The diagnostic results of JNET classification under magnifying endoscopy with blue laser imaging were analyzed,and magnifying chromoendoscopy was further performed for JNET type 2B lesions to evaluate the endoscopic resections of the lesions.Results: A total of 211 lesions from 185 patients were included in this study.There were96 males and 89 females.The age range was 25-82 years old,with a mean age of(58.25±10.86)years old.Lesions: 163(77.3%)in the left colon and 48(22.7%)in the right colon.The lesions were 122(57.8%)≤0.5cm,65(30.8%)0.6-1.0cm,14(6.6%)1.1-2.0cm,and 10(4.8%)> 2.0cm.Endoscopic diagnosis: 138 cases(65.4%)of type 2A lesions,52cases(24.6%)of type 2B lesions,and 21 cases(10.0%)of type 3 lesions.Pathological diagnosis: 8 cases(3.8%)of hyperplastic polyps,142 cases(67.3%)of low-grade dysplasia,35 cases(16.6%)of high-grade dysplasia and superficial submucosal invasion,26 cases(12.3%)of deep submucosal invasion.The diagnostic results of JNET classification under ME-BLI were 88%(122/138),48%(25/52)and 90%(19/21)of the JNET 2A,2B and 3lesions consistent with the pathological diagnosis,respectively.The sensitivity,specificity,PPV,NPV and accuracy of type 2A lesions were 86%,77%,88%,73% and 83%,respectively.The sensitivity,specificity,PPV,NPV and accuracy of type 2B lesions in diagnosis of HGD/SM-s cancer were 71%,85%,48%,94% and 82%,respectively.The sensitivity,specificity,PPV,NPV and accuracy of type 3 lesions in the diagnosis of SM-d cancer were 73%,99%,90%,96% and 96%,respectively.52 patients judged as JNET type2 B were further observed by magnifying chromoendoscopy for PP classification diagnosis,and the coincidence rate with pathological results was 69.2%(36/52).PP classification had significant difference in the accuracy of JNET type 2B typing in predicting pathological types(P<0.05).Conclusions: JNET classification under magnifying endoscopy with blue laser imaging has good diagnostic value in differentiating colorectal neoplastic lesions.For JNET type2 B lesions,combined with PP classification can improve the accuracy of predictive pathological diagnosis.