Differential Diagnosis Of Colorectal Polypoid Leisions With High Definition Intelligent Electronic Staining Endoscopy

Background:The incidence and mortality rates of colorectal cancers are high, and show ascending trend. The etiology of colorectal cancer is still undefined, so there is no targeted first-degree prevention approach. the mortality of colorectal cancer is closely related with the clinical stages, early detection and diagnosis of colorectal cancer is beneficial to improve the patient's prognosis. Most colorectal cancers arise from originally existing adenomas, while non-neoplatic polyps won't generally develop to carcinomas. so early detection and differential diagnosis of the colorectal polypoid lesions have important clinical significance.Objectives:To explore the function of the high definition intelligent electronic staining endoscopy in differentiating diagnosis of colorectal polypoid lesions and compare its i-scan combining with HD+ mode with HD+ mode.Methods:During the procedure of colonoscopy, for every polypoid lesion detected, first using HD+ mode to observe,taking pictures under HD+ mode;Then keep the scene fixed, switching to the i-scan combining with HD+ mode, taking pictures under this mode; All the pictures were read by an experienced endoscopist,according to the Kudo criteria differentiating diagnosis of the polyps under HD+ mode and i-scan combing with HD+mode respectively. If the kudo pattern were not present, according to the experiences.Finally take biopsy of the polyps for pathologic examination. All the data were analyzed with SPSS 17.0,variables were compared for significance with chi-squared test. it is stastically significant if the P value <0.05.Results:We collected 61 cases of patients from 2010 September to 2011 February in qilu hospital of shandong university receiving painless high definition intelligent electronic staining endoscopy examination, A total of 99 polypoid lesions was found, and among them 62 were neoplatic leisions,37 were non-neoplastic leisions confirmed by pathology. Under HD+mode, the pit patterns on the surface of the polyps can be found only on 9 polyps.30 cases were correctly diagnosed to be the non-neoplatic polyps,42 cases were correctly diagnosed to be adenomatous polyps, 20 adenomatous polyps were misdiagnosed to be non-neoplatic lesions, and 7 non-neoplatic lesions were misdiagnosed to be adenomas. under HD+mode, the predictive ability for the polypoid lesions:the sensitivity is 81.08%; the specificity is:67.74%; the positive predictie value is:60%;negative predictive value is:85.71%. Final pathology predicting accuracy is:72.73%. and theκ=0.46.under i-scan combing with HD+ mode, the pit patterns on the surface of the polyps can be found on 88 polyps, according to the Kudo criteria:31 cases were correctly diagnosed to be the non-neoplatic polyps,54 cases were correctly diagnosed to be adenomatous polyps,8 adenomatous polyps were misdiagnosed to be non-neoplatic lesions, and 6 non-neoplatic lesions were misdiagnosed to be adenomas. under i-scan combing with HD+ mode, the predictive ability for the polypoid lesions:the sensitivity is 83.78%; the specificity is:87.10%; the positive predictie value is: 79.49%; negative predictive value is:90%. Final pathology predicting accuracy is: 85.86%. and theκ=0.70.Conclusions:1,The HD+endoscopy was not ideal in differentiating diagnosis of colorectal polypoid lesions, cann't satisfy the demand of early identification,diagnosis of colorectal adenomas in clinical practice.2,The pit patterns on the surface of colorectal polyps can be effectively revealed under I-scan combining with HD+ mode, and the accuracy is high. combined with other characteristics of the lesions, I-scan combining with HD+ endoscopy can achieve efficient endoscopic diagnosis for polypoid lesions real-time.3,In predicting the properties of polyps endoscopically,the i-scan combined with HD+ mode is superior to HD+ mode.4,High definition intelligent electronic staining endoscopy is a new product in endoscopic field, it is still in the initial stage in the clinical practice currently,and its clinical value need further research to clearify.