活检病理提示食管低级别上皮内瘤变发生内镜黏膜下剥离术后病理升级的危险因素分析

Risk factors for under-diagnosis of esophageal intra-epithelial neoplasia with endoscopic forcepsbiopsy in comparison with endoscopic submucosal dissection

目的探讨ESD术前活检提示食管低级别上皮内瘤变（LGIN）发生术后病理升级的危险因素。方法85例ESD术前活检诊断为食管LGIN患者纳入回顾性分析，按ESD术后病理是否升级分组，采用单因素和多因素分析手段探索发生ESD术后病理升级的危险因素。结果45例（52．94％）发生ESD术后病理升级，其中升级至高级别上皮内瘤变38例、早癌7例。37例术前行窄带成像放大内镜（NBI．ME）诊断者，对浸润深度的判断准确率达83．8％（31／37）。多因素分析结果提示黏膜表面发红（OR=9．478，95％CI：2．775～32．368，P=0．0003）及结节样改变（OR=15．628，95％CI：1．475—165．617，P=0．0225）是发生ESD术后病理升级的独立危险因素。结论ESD术前活检诊断食管LGIN发生术后病理升级的情况较为多见，尤应警惕食管黏膜表面发红及结节样改变者，采用NBI—ME检查协同活检的方式对于提高术前评估的准确性具有重要的临床价值。

Objective To study the risk factors for pathological upgrading after diagnosis of esophageal low-grade intra-epithelial neoplasia with ESD preoperative biopsy. Methods The endoscopic and pathological data of 85 lesions with ESD preoperative biopsy were analyzed, and grouped based on pathological upgrading after ESD.The risk factors for pathological upgrading after ESD was studied through single and multiple factor analysis. Results Pathological upgrading occurred in 45 （ 52. 94%） lesions after ESD, among whom 38 lesions developed up to high-grade intra-epithelial neoplasia and 7 lesions developed to esophageal early cancer. NBI-ME was performed on 37 patients and the accuracy of detecting the pathological invasion was 83.8% （ 31/37 ）. Muhi-factor analysis showed that reddish surface （ OR = 9. 478, 95%CI： 2. 775-32. 368, P = 0. 000 3 ） and nodular lesion （ OR = 15. 628, 95% CI： 1. 475-165. 617, P = 0. 022 5 ） were independent factors for pathological upgrading after ESD. Conclusion Pathological upgrading of low-grade intra-epithelial neoplasia was common, especially esophageal mucosa with red surface and nodular lesion.Biopsy combined with NBI-ME is of significant importance to improve diagnostic accuracy.