乙酸染色靶向活检诊断Barrett食管肠上皮化生和异型增生的自身对照研究

A Self-control Study of Acetic Acid Stain-guided Biopsies in Detection of Intestinal Metaplasia and Dysplasia in Barrett's Esophagus

背景：Barrett食管（BE）中的肠上皮化生和异型增生可经内镜活检病理检查得到诊断。目的：评估普通内镜下乙酸染色靶向活检对BE中肠上皮化生和异型增生的诊断价值。方法：纳入2012年1月-2014年11月上海市静安区中心医院内镜下发现食管下段有柱状上皮化生的患者100例,普通内镜下行乙酸染色,于黏膜形态异常处取多点活检,其余BE黏膜常规间隔1~2 cm取四象限活检,比较乙酸染色靶向活检和四象限活检对柱状上皮、肠上皮化生和异型增生的检出率。结果：共96例患者诊断为BE。乙酸染色靶向活检对柱状上皮的检出率为96.9%（93/96）,四象限活检的检出率为90.6%（87/96）。Mc Nemar检验显示,两种方法对柱状上皮的检出率差异无统计学意义（P=0.146）;一致性检验显示,两种方法的一致性较差（κ=0.340）。共32例患者诊断为BE伴肠上皮化生。乙酸染色靶向活检对肠上皮化生的检出率为84.4%（27/32）,四象限活检的检出率为40.6%（13/32）。Mc Nemar检验显示,两种方法对肠上皮化生的检出率差异显著（P=0.007）;一致性检验显示,两种方法的一致性较差（κ=0.266）。此外,共检出5例轻度异型增生,均由乙酸染色靶向活检检出。结论：乙酸染色靶向活检较四象限活检更易检出BE伴肠上皮化生和异型增生。

Background： Intestinal metaplasia（ IM） and dysplasia in Barrett＇s esophagus（ BE） can be detected by endoscopic biopsy combined with pathological examination. Aims： To evaluate the efficacy of acetic acid stain-guided biopsies in detection of IM and dysplasia in BE under standard endoscopy. Methods： One hundred patients found to have columnarlined esophagus by endoscopy from January 2012 to November 2014 at Shanghai Jing ＇an District Central Hospital were enrolled. Under standard endoscopy,acetic acid was sprayed and multi-point biopsies were performed in visible abnormal regions. This was followed by four-quadrant biopsies at every 1 to 2 cm of the remaining BE segments. Detection rates of columnar epithelium, IM and dysplasia were compared between acetic acid stain-guided biopsies and four-quadrant biopsies. Results： A total of 96 patients were diagnosed as BE. Detection rates of columnar epithelium by acetic acid stainguided biopsies and four-quadrant biopsies were 96. 9%（ 93 /96） and 90. 6%（ 87 /96）,respectively,no significant difference was found between the two methods（ Mc Nemar test,P = 0. 146）,however,consistency of the two methods was poor（ κ = 0. 340）. A total of 32 patients were diagnosed as BE with IM. Detection rates of IM by acetic acid stain-guided biopsies and four-quadrant biopsies were 84. 4%（ 27 /32） and 40. 6%（ 13 /32）,respectively,difference in detection rate between the two methods was significant（ Mc Nemar test,P = 0. 007）,and consistency of the two methods was poor（ κ =0. 266）. Five cases of low-grade dysplasia were detected by acetic acid stain-guided biopsies only. Conclusions： Acetic acid stain-guided biopsies can detect BE with IM and dysplasia better than four-quadrant biopsies.