摘要
背景:结直肠肿瘤样病变内镜黏膜切除术(EMR)后病理诊断与术前内镜活检病理诊断的差异未明。目的:评估放大色素内镜指导下EMR获得的结直肠肿瘤样病变标本的诊断价值。方法:连续收集接受EMR治疗的直径≤2 cm的无蒂型或平坦、凹陷型结直肠肿瘤样病变纳入研究,分析EMR病理诊断与术前活检病理诊断的差异。结果:共纳入EMR切除病灶90个,无蒂型25个,平坦、凹陷型65个,后者为高度异型增生(HGD)或腺癌的可能性略高于前者(41.5%对20.0%,P>0.05)。术前活检病理诊断的总体准确性为68.9%,28个(31.1%)病灶的诊断于术后发生改变,其中4个增生性病变术后均诊断为低度异型增生(LGD),14个LGD诊断为HGD,5个LGD诊断为腺癌,5个HGD诊断为腺癌。病灶形态学表现及其浸润深度与病理诊断结果的改变无关。结论:放大色素内镜指导下的EMR病理诊断纠正了本组近1/3结直肠肿瘤样病变的术前活检病理诊断,具有完善诊断和治疗的双重作用。
Background: The difference of pathological diagnosis based on endoscopic mucosal resection (EMR) and endoscopic biopsy prior to EMR in patients with colorectal neoplasia has not been clear yet. Aims: To evaluate the diagnostic value of specimens obtained by EMR under the guidance of magnifying chromoendoscopy for colorectal neoplasia. Methods: Consecutive patients with colorectal neoplasia fulfilling the following criteria undergone EMR were enrolled in this study: ≤ 2 cm in diameter; sessile or flat/depressed neoplasia. The pathological diagnosis of pre- and post-EMR was compared. Results: Ninety lesions, including 25 sessile and 65 flat/depressed were resected by EMR. High grade dysplasia (HGD) and adenocarcinoma were detected in the fiat/depressed lesions more often than in the sessile lesions (41.5% vs. 20.0%, P〉0.05). The overall diagnostic accuracy of pre-EMR biopsy was 68.9%. Alterations of pathological diagnosis occurred in 28 lesions (31.1%), including 4 hyperplastic lesions changed to low grade dysplasia (LGD), 14 LGD changed to HGD, 5 LGD changed to adenocarcinoma, and 5 HGD changed to adenocarcinoma. Both the morphology of lesions and their infiltrating depth were not correlated with the changes of pathological diagnosis. Conclusions: Nearly 1/3 of the pathological diagnoses made by biopsy at conventional colonoscopy are corrected after EMR in this study. EMR under the guidance of magnifying chromoendoscopy has a dual effect of enhancing the diagnosis and treatment for colorectal neoplasia.
出处
《胃肠病学》
2009年第10期604-606,共3页
Chinese Journal of Gastroenterology
基金
上海市重点学科建设项目资助(项目编号:Y0205)