现场询问调查上消化道癌胃镜检查漏诊

An interview investigation for prevalence of missed upper gastrointestinal cancer diagnosis after gastroscopy in Chinese patients

目的了解我国胃镜检查上消化道癌(upper gastrointestinal cancer,UGC)的漏诊率及其原因。方法本研究属于回顾性队列研究,2012年1月-2014年3月,对于在本院内镜室确诊的UGC患者,在患者或家属领取病理报告时,现场询问其既往胃镜检查史,3年内曾有过胃镜检查但诊断为良性病变者定义为漏诊,而3年以上者定义为潜伏癌。通过漏诊癌和潜伏癌特征的比较进行漏诊易患因素分析。结果经过27个月的调查,共完成胃镜检查31 825例,确诊UGC 280例(0.9%),失访5例,275例UGC患者中有53例(19.3%)既往至少接受过1次胃镜检查,其中漏诊癌27例(9.8%)、潜伏癌26例(9.5%);在27例漏诊癌患者中,首次胃镜检查未发现病灶14例(51.9%),发现病灶但未做活检4例(14.8%),病灶活检而病理报告为良性9例(33.3%);在13例已发现病灶的漏诊病例中,9例是胃溃疡。单变量分析显示非胃窦部位和高级别医院检查是漏诊的易感因子。结论 UGC胃镜漏诊情况在我国常见,病灶在非胃窦区及在高级别医院检查与漏诊相关。

Objective To explore the prevalence of missed upper gastrointestinal cancer （UGC） diagnosis after gas- troscopy in China and to identify risk factors that may contribute to these missed diseases. Methods A retrospective co- hort study was conducted. From Jan. 2012 to Mar. 2014, patients diagnosed with UGC were interviewed for their histo- ries of previous gastroscopy. Missed and latent cancers were classified as to whether they were detected within 3 years af- ter the initial gastroscopy. Possible predisposing factors were identified through characteristic comparisons between missed and latent cancers. Results During the 27-month study, 31 825 gastroscopies were performed, and UGC was di- agnosed in 280 cases （0.9%）. Of 275 UGC patients interviewed, 53 cases（ 19.3% ） reported undergoing at least one prior gastroscopy before receiving their final diagnosis. Among the interviewed patients, 27 cases had missed cancers （9.8%） and 26 cases had latent cancers （9.5%） within 3 years of a gastroscopy. Lesions not seen by endoseopists, lesions seen but not biopsied, and lesions with benign biopsy reports accounted for 51.9% （ n = 14） , 14.8 % （ n = 4） , and 33.3% （n = 9） of the 27 missed cases, respectively; Of the 13 reported lesions （latter 2 categories） , 9 cases （69.2%） were gastric ulcers. A univariate analysis revealed that 2 factors were associated with missed cancers： tumor origination outside of the antrum and gastroscopies being performed at higher-level hospitals. Conclusion Missed UGC diagnosis following initial gastroscopy occurrs frequently in China. Tumors origination outside of the antrum and gastros- copies being performed at higher-level hospitals are predisposing factors for missed diagnosis.