| ObjectiveThe global incidence of colon cancer has increased year by year.At present,the number of colon cancer cases in China exceeds 250,000.The occurrence and development of colon cancer is closely related to polyps.It is especially important for the differential diagnosis of polyps.Adenomatous polyps are the most common precancerous lesions.Early resection of adenomatous polyps is of great significance in reducing the risk of colon cancer.Ordinary white light endoscopy can detect more polyps,but can't accurately determine the nature of polyps,can only wait for pathological results,there is a certain blindness,easy to miss diagnosis,and more than 50% of polyps are inflammatory hyperplasia,all resection,Not only waste of resources,increased risk of biopsy,but also the complications of colonoscopy.In order to improve the ability to identify polyps,timely discover adenomatous polyps,and overcome the shortcomings of white light endoscopic observation limitations,the development and application of new imaging technologies are needed.Our team independently constructed a new device for high-resolution microendoscopy(HRME)that can acquire virtual tissue images of the digestive tract mucosa in real time.This study used a high-resolution microscopic imaging system to perform colon polyps of different pathological types.Observe,extract image features,establish diagnostic criteria,study the diagnostic value of HRME for different types of polyps and beginners' difficulty in learning HRME,develop a HRME scoring system for intraepithelial neoplasia,and explore HRME for adenomatous polyps Graded diagnostic value of intraepithelial neoplasia.Methods1.145 cases of polyp specimens underwent endoscopic resection in colonoscopy in our hospital from December to May 2018,2017.All patients were informed of informed consent before examination.The book uses HRME to image the specimen in vitro and preserve clear images for research and analysis.This study has been approved by the hospital ethics committee.2.According to the pathological diagnosis results,the stored 4699 HRME images were sorted and sorted.After careful screening,1563 images were selected and included in the study.The endoscopic physician and pathologist jointly identified the image features,and 20 images of 20 colon polyps were retrospectively analyzed to summarize the HRME image characteristics of different pathological types of polyps and to establish HRME diagnostic criteria.3.According to the established diagnostic criteria,45 systematically trained physicians performed HRME imaging on 45 specimens of colon polyps,collected images and made diagnosis,and compared HRME diagnosis results with pathological results to evaluate different classifications of HRME.The diagnostic value of polyps.4.Select the HRME images of different pathological types of polyps in the previous study as the initial learning set,including 10 inflammatory polyps,hyperplastic polyps,tubular adenomas,villous adenomas,villous tubular adenomas,and serrated adenomas.A total of 60 images.The HRME images of 40 polyps were selected,and 10 images were selected for each case,a total of 400 images.The images were stored in 40 folders and randomly divided into 4 groups.An experienced HRME physician explained the image characteristics and diagnostic criteria of the concentrated HRME for the two beginner physicians(Physician C and Doctor D).The two beginners made a diagnosis after three stages of study and recorded the correct number of diagnoses.According to the learning curve,the beginners' evaluation of the difficulty of HRME is evaluated.5.Based on the HRME diagnostic criteria,a total of 433 images of 40 cases of adenomatous polyps with intraepithelial neoplasia were included in the intraepithelial neoplasia study.HRME images of 25 cases of adenomatous polyps with intraepithelial neoplasia were used to analyze and develop HRME scoring criteria,including 13 cases of high-grade intraepithelial neoplasia and 12 cases of low-grade intraepithelial neoplasia,by two physicians(Physician C,Physician D)scored according to the established HRME scoring criteria,and the statistical analysis showed the best score.According to the HRME scoring criteria,the HRME images of 15 cases of adenomatous polyps with intraepithelial neoplasia with clear pathological results were scored,the scores were recorded,the grading was diagnosed according to the scores,and the diagnosis results were compared with the pathological results to evaluate the HRME pairs.The diagnostic value of adenoma with high-grade intraepithelial neoplasia.Results1.According to the changes of morphological structure,number,glandular epithelial structure,goblet cells and crypts of colon tissue,combined with pathological diagnosis results,the diagnostic criteria of HRME for different types of polyps were established.Inflammatory polyps: the gland is structurally intact,the crypts are round,the arrangement is relatively uniform,the number of crypts is reduced,the goblet cells are present,and the glandular epithelium is evenly distributed;the hyperplastic polyps can be seen: the gland is structurally intact,and a small number of glands are visible.Fusion,crypt volume increases,opening dilation,and normal crypt structure,the arrangement is basically symmetrical,goblet cells exist,glandular epithelial thickness is uniform;tubular adenoma can be seen: gland structure is incomplete,can't see normal crypt Structure,crypts have long tubular dilatation,branching changes,goblet cells are missing;villous adenomas can be seen: glandular structure is irregular,no normal crypt structure,a large number of long villi structures can be seen in the epithelium;villous tubular adenomas can be seen At the same time,the tubular and branched crypt structures with twisted expansion and the epithelium with the appearance of a fluff-like brush border can be seen,and the goblet cells are missing;the serrated adenoma can be seen: the gland structure is mildly disordered,the crypt opening is dilated,and the crypt opening the sawtooth structure changes.2.In 45 specimens of colon polyp biopsy,HRME was diagnosed as inflammatory polyps in 12 cases,hyperplastic polyps in 5 cases,tubular adenoma in 10 cases,villous adenoma in 3 cases,villous tubular adenoma in 12 cases,and serrated adenoma in 3 cases.The pathological diagnosis included 13 cases of inflammatory polyps,6 cases of hyperplastic polyps,8 cases of tubular adenomas,3 cases of villous adenomas,11 cases of villous tubular adenomas,and 4 cases of serrated adenomas.The sensitivity,specificity,accuracy,PPV and NPV of HRME for different types of polyp diagnosis were inflammatory polyps(85.6%,95.4%,92.5%,90.5%,94.3%)and hyperplastic polyps(74.4%,95.1).%,91.2%,77.8%,92.6%),tubular adenomas(73.2%,93.7%,88.5%,82.6%,90.3%),villous adenomas(72.7%,95.9%,92.9%,72.7%,95.9)%),villous tubular adenoma(75.8%,96.9%,95.4%,88.6%,95.1%),serrated adenoma(77.0%,94.6%,89.2%,84.4%,92.5%).3.After repeated study by the two clinicians,the number of cases in which the correct diagnosis of polyps was correctly performed by physician A after three stages of learning was 26,34,and 37,respectively.The number of cases in which doctor B correctly diagnosed polyps after three stages of study was 30,35,and 39.After learning,beginners can master and skillfully apply HRME for diagnosis in a short time.4.The scores of the lower grade intraepithelial neoplasia of the gland were lower than those of the high grade intraepithelial neoplasia of the gland.The scores of the two physicians were analyzed by ROC curve.The best cutoff value of the two doctors(Cut off value)is 8,that is,when the score is greater than or equal to 8,the glandular high-grade intraepithelial neoplasia can be diagnosed.The sensitivity and specificity of physician C were 84.62% and 75%,and the sensitivity and specificity of physician D were 84.62% and 83.33%.The Kappa index of the two physicians was 0.67 and the scores were moderately consistent.5.Graded diagnosis of lesions according to the established scoring criteria.HRME diagnosed 9 cases of high grade intraepithelial neoplasia,6 cases of low grade intraepithelial neoplasia,8 cases of high grade intraepithelial neoplasia and 7 cases of low grade intraepithelial neoplasia.The sensitivity,specificity,accuracy,PPV,and NPV of HRME diagnosed as high-grade intraepithelial neoplasia were 87.5%,71.4%,80.0%,77.8%,and 83.3%,respectively,and the consistency with pathological diagnosis was 0.62.Conclusion1.HRME can accurately image different pathological types of polyps and has a high diagnostic value,which is of great significance for guiding clinical treatment to prevent cancer.2.Beginners can complete the study of HRME image features and diagnostic criteria in a short time,the diagnosis rate of lesions is higher and the speed of improvement is faster,fully demonstrating the advantages of HRME easy to learn and easy to apply,suitable for clinical application.3.HRME based on gland structure,glandular epithelial thickness,cell alignment,the development of intraepithelial neoplasia scoring system,preliminary realization of the classification of intraepithelial neoplasia,to lay the foundation for further diagnosis of lesions. |
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