胃上皮内瘤变及早癌内镜切除术前后病理观察结果对比分析

Comparison of the pathological changes of intraepithelial neoplasia and early gastric carcinoma before and after endoscopic submucosal dissection

目的通过对胃内镜下黏膜切除术(EMR)及内镜黏膜下剥离术(ESD)获得的上皮内瘤变及早癌标本的病理学观察,探讨术前及术后病理诊断差异的原因及改善方法。方法根据WHO(2010)消化系统肿瘤组织学分类和Vienna分类,分别对62例胃EMR/ESD术前及术后病理观察和诊断,并比较其差异。结果术前、术后病理诊断完全一致率69.4%(43/62),术前低级别上皮内瘤变(3类)诊断一致率73.5%(25/34),高级别上皮内瘤变(4类)诊断一致率58.3%(14/24),浸润性癌(5类)诊断一致率100%(4/4)。其中高级别上皮内瘤变术后级别升高占41.7%(10/24)。结论胃黏膜活检及EMR/ESD术后病理诊断符合率偏低,主要表现为术后级别升高,术前病理诊断不能完全代表胃黏膜病变的性质,处理不应仅局限于定期内镜随访或组织活检的病理信息,有条件的应结合内镜形态并积极行EMR/ESD治疗。

Objective To investigate the reason and the difference of preoperative and postoperative pathological diagnosis by observing the pathological changes in intraepithelial neoplasia and early carcinoma by endoscopic submucosal dissection （ESD）. Methods According to WHO classification and Vienna classification of esophageal gastrointestinal epithelial tumor, preoperative and postoperative pathological examination and diagnosis were compared in 62 cases of esophageal endoscopic submucosal dissection. Results The pathological diagnosis consistency rate of preoperative and postoperative was 69.4% （43/62）, the rate of low-grade intraepithelial neoplasia （ category 3 ）, high-grade intraepithelial neoplasia （ category 4 ） and invasive carcinoma were 73.5% （25/34） , 58.3 % （ 14/24 ） and 100% （4/4） , respectively. High-grade intraepithelial neoplasia increased by 41% after operation. Conclusion The diagnosis of esophageal and gastric mucosa biopsy and pathological diagnosis after ESD are relatively lower; preoperative pathological diagnosis cannot completely represent the nature of esophageal gastric mucosal lesions. Treatment should not be limited to regular endoscopic follow-up or biopsy of pathological information. The treatment of ESD should be carried out actively.