胃镜活检诊断食管高级别上皮内瘤变的可靠性分析

摘要

Objective To investigate the histopathology of endoscopic submucosal dissection ( ESD) specimens of esophageal high-grade intraepithelial neoplasia ( HGIN) diagnosed by endoscopic forceps biopsy and correlate with endo-scopic characteristics to predict the risks of cancer. Methods The information from 92 patients who underwent ESD for HGIN in the First Affiliated Hospital of Nanjing Medical University was retrospectively reviewed from Dec. 2012 to Apr. 2015. The clinical manifestation, endoscopic appearance and histopathological information were collected. All the enrolled patients were divided into concordant group (80 cases) and upgraded group (12 cases) according to the patho-logical results before and after ESD. The endoscopic characteristics before and after ESD were compared and the risk factors for discrepancy before and after ESD of esophageal HGIN were analyzed. Results Among the enrolled 92 patients, histology of ESD specimens led to a change in diagnosis in 13. 0% of the focal lesions and a relevant change in treatment policy in 6. 5% . There were no significant differences in demographics, endoscopic and histopathologic features between concordant group and upgrade group, including gender, tumor location, erythema, nodularity, whitish fur, the number of biopsy and Lugol staining (P >0. 05). The data of the cases including age ≤60 years old, the lesion size >2 cm, with erosion and macroscopic pattern were significant more frequently in the upgraded group than those in the concordant group (P<0. 05). Further multivariate regression analysis demonstrated that the lesion size >2 cm, macroscopic patternl including 0-Ⅰ and 0-Ⅱc of focus as independent risk factors for upgraded pathology. Conclusion For the lesions of pre-ESD histological diagnosis as HGIN, the lesion size >2 cm, 0-Ⅰand 0-Ⅱc patterns to be the in-dependent risk factors for histological changes, and we need to be vigilant against the possibility of missing cancer.%目的 探讨食管黏膜病灶活检病理为高级别上皮内瘤变( high-grade intraepithelial neoplasia,HGIN)经内镜黏膜下剥离术( endoscopic submucosal dissection,ESD)证实癌变的内镜下特点相关风险因素.方法 回顾2012年12月至2015年4月在南京医科大学第一附属医院92例经ESD治疗且术前活检诊断为食管HGIN患者的病例资料,根据ESD前后病理结果分为一致组(80例)和癌变组(12例),统计分析两组病灶内镜下特点的差异.结果 纳入患者中病理升级率为13. 0% (12/92),治疗决策改变占6. 5% (6/92).两组患者性别、病变部位、红斑、结节、白斑、活检块数及碘染色相比,差异无统计学意义(P>0. 05).单因素分析提示,两组患者年龄、病变长径、糜烂及大体类型相比,差异有统计学意义(P<0. 05),纳入多因素分析结果显示,病变长径>2 cm及大体类型的0-Ⅰ、0-Ⅱc是活检病理为食管HGIN病理升级的独立危险因素.结论 对于活检病理提示HGIN的食管黏膜病灶,如病变长径>2 cm或大体类型0-Ⅰ、0-Ⅱc,需警惕活检漏诊癌变的可能.