结直肠肿瘤样病变内镜活检与黏膜切除术后病理诊断比较

Comparison of Pathological Diagnosis Based on Endoscopic Biopsy and Endoscopic Mucosal Resection in Patients with Colorectal Neoplasia

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.