早期食管癌及癌前病变的内镜特点及治疗前后病理诊断的对比分析

Accuracy of preoperative endoscopic diagnosis of early esophageal cancer and precancerous lesions

目的评价早期食管癌及癌前病变的内镜特点,比较术前、术后病理诊断的符合率,为食管上皮内瘤变的内镜治疗提供依据。方法收集2010年1月至2015年1月所有因早期食管癌及癌前病变行内镜下治疗的患者共89例,92处病灶,分析内镜下特征及术前、术后病理诊断的一致率。结果术前、术后病理诊断完全一致率69.6%(64/92),其中术前低级别上皮内瘤变(3类)诊断一致率71.4%(35/49),高级别上皮内瘤变(4类)诊断一致率53.3%(16/30),浸润性癌(5类)诊断一致率100.0%(13/13)。术后4类及5类病灶与1、2、3类病灶平均最大直径和面积的比较差异均有统计学意义(P<0.05或0.01)、4、5类间病灶大小、部位的比较差异均无统计学意义(均P>0.05),但两者在内镜形态上差异有统计学意义(P<0.05)。结论术前病理诊断不能完全代表食管黏膜病变的性质,对于食管低级别上皮内瘤变者,若病变直径>20mm或为Ⅱc病变者,应尽快选择内镜下治疗。

Objective To evaluate the preoperative endoscopic diagnosis of early esophageal cancer and precancerous lesions. Methods Eighty nine patients with early esophageal cancer or precancerous lesions （92 lesions） were treated with endoscopic surgery in the Affiliated Hospital of Ningbo University Medical College between January 2010 and January 2015. The concordance of preoperative and postoperative pathological diagnosis was analyzed. Results The overall consistency rate of preoperative and postoperative pathological diagnosis was 69.6%. For low-grade intraepithelial neoplasia （category 3）, high-grade intraepithelial neoplasia （category 4） and invasive neoplasia （category 5）, the diagnostic consistency were71.4%, 53.3% and 100.0%, respectively. There were significant differences in maximum diameter and area between categories 4, 5 and categories 1, 2, 3 （P〈0.05）; while no difference between category 4 and 5, but there were significant differences in endoscopic characteristics between two categories. Conclusion Preoperative biopsy is insufficient for accurate diagnosis of esophageal mucosal lesions. For esophageal low-grade intraepithelial neoplasia, if the lesions is belong to il c or diameter over 20mm,endo-scopic resection should be first considered.