食管粘膜活检取样误差的发生机制及对策

The mechanism and strategy of esophageal sampling procedure

目的：探讨食管粘膜活检取样误差的发生机制及对策。方法：对来自河南食管癌高发区２８例患者行食管内镜检查和中、下段粘膜活检组织病理检查，１０天短期随访后对同一人群作重复检查；并对８８位无症状受检者进行碘染与活检相结合的方法。结果：第二次粘膜活检组织中，食管中段２４％的患者病变减轻，２８％的患者病变加重，４８％的患者病变维持不变。食管下段粘膜活检中，４８％的患者病变减轻，１６％的患者病变加重，３２％的患者病变维持不变；碘染受检者的食管粘膜中染色正常和染色异常的粘膜组织在癌前病变各阶段的构成比无明显差异。组织形态学测量显示：各级癌前组织与正常上皮组织的厚度无明显差异。结论：粘膜活检取样误差可严重影响组织病理学检查随访结果。食管粘膜癌前病变，特别是较轻度病变的厚度与同期正常上皮无明显改变，造成内镜下识别困难，是造成取样误差的重要因素。碘染可明显提高内镜下病变与同期正常组织的识别，但对小范围病变的活检准确度仍需改进。肿瘤抑制基因ｐ５３蛋白聚集的重复性检出率较高，可能是食管癌变过程中的有效指标。

Objective: To explore the mechanism of biopsy Sampling procedure in the detection of esophageal precancerous lesions and to establish the strategies for improving reproducibiligy through target biopsy.Methods:biospies were taken from the middle-third and the lower-third of the esophagus of 28 subjects from a high incidence area of esophageal cancer in Henan, China.The Sampling procedure was repeated on the same subjects 10 days later. During this pened,all subjects followed their usual dietary habits. 88 symptom-free subjects from the same high incidence area for. esophageal cancer in Henan, China were examined by endoscopy combined with iodine staining and targeted biopsy. Results: In the second sampling from the middle- third of the esophagus,24% of the subjects had less severe lesions,28% had more severe lesions and 48% had the same seventy of lesions. In those from the lower-third of the esophagus,48% of the subjects had less severe lesions, 16% had more severe lesions and 32% had the same seventy of lesions. Statistics analysis showed that there was no difference in the proportions of esophageal precancerous lesions between the staining mucosa and the unstaining mucosa. Conclusion:Histological mophomoty analysis indicated that there were no difference in epithelial thickness among the normal tissues with different severity of lesions. The biopsy sampling procedure was a key effector to influence the follow-up results of histopathology.The similar thickness among the nounal tissue and the diseased tissue, (especially in the less seventy lesions,which resulted in difficulties of recognition for precancerous lesions under endoscopy was the key mechanism for poor reproducibility.Iodine staining can improve the recognition for the normal and diseased epithelia, however, the target biopsy for the local lesions still need to be improved. High reproducibility of p53 protein immunostaining indicates that p53 seems to be a promising biomarker in esophageal carcinogenesis.