早期胃癌内镜下色泽改变与分化程度的关联

Correlation between endoscopic color changes and tumor differentiation in early gastric cancer

目的分析早期胃癌内镜下色泽改变与活检及手术病理学分化程度之间的关联,以提高常规内镜检查的诊断价值。方法回顾性分析2007年1月～2008年3月间经手术病理学证实、术前内镜图像可供分析的早期胃癌113例,对其病变的内镜下色泽改变进行分类,并以手术病理学结果为基准,对早期胃癌色泽改变与活检病理学在预测癌组织整体分化程度的能力进行分析。结果113例早期胃癌患者中,明显色泽改变有62例(54.9%),其中男性40例,女性22例,年龄(55.6±8.8)岁,均为单发病灶。色泽改变以充血最为多见,部分病例表现为充血与褪色混杂。将62例病灶分为P、M、E型3种色泽,其中P型21例,M型34例,E型7例。病变不同的色泽改变模式与胃癌组织学分化程度关联较密切,P型以分化癌居多(13/21,61.9%),M型大多为未分化癌(29/34,85.3%),而E型均为分化癌(7/7,100%)。内镜下色泽改变预测整体分化程度的准确度在分化癌与未分化癌之间差异不大(80.0%比78.4%);而对于分化癌,活检病理学判断的准确度不佳(36.0%)。总体而言,通过内镜下病变色泽变化判断早期胃癌分化程度的准确度略优于活检病理学(79.0%比62.9%),但差异尚不具统计学意义(P=0.414)。结论逾半数的早期胃癌病灶存在明显的色泽改变。色泽改变与早期胃癌的整体分化程度之间存在关联,根据色泽改变判断早期胃癌分化程度的准确度与活检病理学相仿。

Objective To analyze the correlation between endoscopic color changes, biopsy results and overall tumor differentiation in early gastric cancer, and enhance the diagnostic value of routine upper GI endoscopy. Methods One-hundred and thirteen consecutive early gastric cancer patients were analyzed from January 2007 to March 2008. The color change patterns of early gastric cancer were studied and the diagnostic accuracy of color change observation and biopsy pathology in predicting overall tumor differentiation were compared. Results Marked color changes were observed in 62 patients（54.9 %） including 40 males and 22 females, mean age 55.6 years. Congestion redness were the most common color changes in early gastric cancer, then followed by a mixed pattern of congestion redness and discoloration. Lesions with sole discoloration were not observed. The color changes were then classified into 3 types： palisade（P, 21/62）, mixed（M, 34/62） and elevated（E, 7/62）. The color change patterns were related to tumor differentiation. Differentiated cancer was more frequently found in type P lesions （13/21, 61.9 %） while type M and E were dominated by undifferentiated （29/34, 85.3 %） and differentiated cancer（7/7, 100 %）, respectively. Difference was not observed in the predictive accuracy of color change between differentiated and undifferentiated cancer（80.0 % vs 78.4 %）, while biopsy pathology presented poor accuracy in differentiated cancer（36.0 %）. The overall diagnostic value of endoscopic color change observation tended to be better than biopsy pathology, yet the difference did not reach a statistically significant level（P = 0.414）. Conclusion Marked color changes exist in more than half of early gastric cancer lesions. The correlation between endoscopic color changes and the dominant tumor differentiation is available. The overall diagnostic value of endoscopic color change observation in predicting tumor differentiation is similar to that of biopsy pathology.