| Background and Objective With the popularity of colonoscope screening,the incidence of left colon cancer tends to decrease,and the incidence of right colon cancer is gradually increasing,which may be related to the missed detection of SSA/P under endoscopy.The molecular characteristics of CRC of the right colon and SSA/P are very similar,including Cp G island methylation,BRAF gene mutation and microsatellite high instability.Most of the SSA/P locats in the right colon,flat and sessile,pale in color,and rich in mucus on the surface.After removing mucus of the lesion,the color is similar with surrounding mucosa.The morphological features of SSA/P and HP are similar,and it is difficult to identify.The malignant potential of SSA/P and HP are different needed to be treated differently.Early detection and recognition of SSA/P,complete resection and regular follow-up are the fundamental and effective methods to prevent it's malignant progression.In order to make SSA/P early identify,diagnosis and treatment,we will explore the methods of identification and prediction SSA/P and HP through a comprehensive understanding of the microstructure and morphological features of their under NBI.Materials and methods Retrospectively analyzed the slides of pathological sections of the colorectal polyps detected by Second Affiliated Hospital of Zhengzhou University endoscopy room from January 2014 to April 2017,collecting the clinical and endoscopic data of pathological diagnosis were SSA/P with or without dysplasia.All the lesions were used white-light endoscopy and NBI mode observing nearly and saving the images,with complete clinical endoscopic data,randomly matching the same number of HP in the same period.SSA/P were 57 cases,with dysplasia were 7 cases.57 cases of SSA/P came from 47 patients,25 men,22 women,and the average age was(58.6 ± 11.4)years.57 cases of HP came from 45 patients,25 men,20 women,and the average age was(55.5 ± 9.1)years.The morphological features of SSA/P were carefully observed under the white light endoscopy combined with narrow-band imaging,including Pit pattern and capillary network Sano type.According to the study of Hazewinkel combing with other morphological features like size,location,morphology type of colorectal tumour,mucus cap,black dots of the surface,cloud-like surface,regular or irregular shape and clear or fuzzy boundary to identify and diagnosis SSA/P.All endoscopy images were assessed by 2 endoscopist with experience in mucosal microstructures and submucosal microvascular identification.SPSS 20.0 statistical software was used to analyze the data.Results(1)Morphologic classification of colorectal tumor in SSA/P and HP under white-light endoscopy The average diameter between two groups was no difference(P<0.05),and SSA/P was commonly lager than HP.In morphologic classification of colorectal tumor: SSA/P had 2(3.5%)case of type Ip,2(3.5%)case of type Isp,15(26.3%)cases of type Is,27(47.4%)cases of type IIa,11(19.3%)cases of type IIb.HP had 2(3.5%)cases of type Ip,3(5.2%)cases of type Isp,11(19.3%)cases of type Is,25(43.9%)cases of type IIa,16(28.1%)cases of type IIb.There was no difference in morphological classification of colorectal tumors between the two groups(x2 =9.619,P>0.05).(2)Pit pattern of SSA/P and HP under NBI Pit pattern in colorectal mucosa: SSA/P without dysplasia had 12(26%)cases of type II,37(74%)cases of type II-O.SSA/P with dysplasia had 1(1/7)case of type II-O,2(2/7)cases of type III,4(4/7)cases of type IV.HP had 9(15.8%)cases of type I,45(78.9%)cases of type II,3(5.3%)cases of type II-O.The main Pit pattern of SSA/P without dysplasia was type II-O.The main Pit pattern of SSA/P with dysplasia were type III and type IV.The main Pit pattern of HP was type II.There was significant difference on Pit pattern among three groups(x2 =96.146,P<0.05).(3)The capillary network Sano type of SSA/P and HP under NBI The Sano type under NBI: SSA/P without dysplasia had 38(84.0%)cases of CP: type I,12(16.0%)cases of CP: type II.SSA/P with dysplasia had 1(1/7)case of CP: type I,6(6/7)cases of CP: type II.HP had 50(87.7%)cases of CP: type I,7(12.3%)cases of CP: type II.There was significant difference in the Sano typing among three groups(x2 =16.083,P<0.05).(4)Morphological features of SSA/P and HP under NBI The results of morphological features analysis under NBI showed that: red mucus cap,surface black dots,cloud-like surface,II-O Pit pattern,surface microvascular network,irregular shape,and fuzzy boundary were more common in SSA/P than in HP(P<0.05).Red mucus cap was more common in SSA/P than in HP(47 vs 13,x2 =40.674,P<0.05);The black dots on the surface of SSA/P was more common than that of HP(46 vs 16,x2 =31.824,P<0.05).Cloud-like surface was more in SSA/P than in HP(36 vs 4,x2 =39.438,P<0.05).II-O gland opening was more in SSA/P than in HP(38 vs 3,x2 =46.659,P<0.05).Vascular network was more in SSA/P than in HP(18 vs 7,x2 =6.200,P<0.05).Irregular shape was more in SSA/P than in HP(34 vs 14,x2 =14.394,P<0.05).Fuzzy boundary were more common in SSA/P than in HP(36 vs 13,x2 =18.934,P<0.05).(5)Identifying and predicting of SSA/P and HP by single morphological features under NBI A single morphological feature was used to predict SSA/P and HP: The sensitivity of red mucus cap(OR,3.9;95%CI,2.6-6.0)was 82.5%,and the specificity was 77.2%.The sensitivity of II-O Pit pattern(OR,4.2;95%CI,2.8-6.3)was 66.7%,and the specificity was 94.7%.we found that in the identification and prediction of SSA/P and HP by a single morphological feature: the sensitivity of red mucus cap was higher than other morphological features,and the specificity of II-O Pit pattern was higher than other morphological features.(6)Identifying and predicting of SSA/P parallelling with 3 morphological features The results show that red mucus cap and II-O type pit pattern with other morphological features parallelling could significantly improve the sensitivity of each morphological features in identification and prediction compared with single morphological features,and he coincidence rate was slightly higher,but the specificity was lower.Therefore,we recommended to combine red mucous cap and II-O type pit pattern with other morphological features under NBI to identify and predict SSA/P and HP could achieve the purpose of screening SSA/P in colonoscopy.Conclusions(1)There is an unique II-O Pit pattern in SSA/P,and the Pit pattern of SSA/P with dysplasia can appear type III and type IV.(2)The Sano type of SSA/P without dysplasia mainly is CP: type I,and SSA/P with dysplasia mainly is CP: type II.(3)SSA/P has the morphological features of the red mucous cap,surface black dots,cloud-like surface,II-O Pit pattern,surface vascular network,irregular morphology and fuzzy boundary under NBI.The sensitivity of red mucus cap is higher than other morphological features,and the specificity of II-O Pit pattern is higher than that other morphological features in identification and prediction of SSA/P with HP under NBI.(4)It is recommended to combine red mucus cap and II-O Pit pattern with other morphological features to diagnose and predict SSA/P and HP under NBI can achieve the purpose of predicting and diagnosing SSA/P by endoscopy. |
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