食管上皮内瘤变内镜活检与术后标本病理结果差异分析

Discrepancy between endoscopic forceps biopsy and endoscopic resection in esophageal intraepithelial neoplasia

[目的]分析比较上皮内瘤变或早期食管癌(early esophageal cancer,EEC)患者内镜活检与内镜切除术后病理差异。[方法]收集经内镜活检诊断的182处食管上皮内瘤变或EEC病变患者的临床资料,对比术前后病理结果,分析患者临床及内镜特点,探索发生术后病理升级的危险因素。[结果]活检提示食管低级别上皮内瘤变(lowgrade intraepithelial neoplasia,LGIN)43处,高级别上皮内瘤变(high-grade intraepithelial neoplasia,HGIN)112例,EEC27处。术前活检与金标准比较总体符合率为68.7%(125/182),病理升级率为31.3%(57/182);LGIN组符合率为37.2%(16/43),HGIN组为73.2%(82/112),EEC组为100%(27/27),差异有统计学意义(P<0.01)。病变表面有结节、联合碘染色或窄带成像技术(narrow-band imaging,NBI)或超声内镜(endoscopic ultrasound,EUS)的靶向取检以及标本最长径与术后病理升级有关(P<0.05)。[结论]内镜活检对于食管上皮内瘤变及EEC的病理诊断存在局限性,活检诊断LGIN发生术后病理升级较为多见,因此对于表面有结节及长径较长的病灶,联合碘染色或NBI或EUS进行靶向取检对提高术前评估准确性有重要的临床价值。

[Objective]Analyzed the histopathologic characteristics of specimens collected during endoscopic resection（ER）compared with biopsy specimens from patients with esophageal intraepithelial neoplasia（IEN）or early esophageal cancer（EEC）. [Methods]From January 2014 to April 2017, a total of 182 lesions diagnosed as IEN or EEC by endoscopic forceps biopsy（EFB） were enrolled. A detailed histologic analysis was performed for each ER and EFB to exploring the risk factors for pathological upgrade after ER. [Results]According to the histological types of the EFB specimens,there were 43 lesions with low-grade intraepithelial neoplasia （LGIN）, 112 with high-grade intraepithelial neoplasia （HGIN）and 27 with EEC. Although concordant in most（68.7 %）cases between EFBs and gold standard, pathological diagnoses in 57（31.3%）cases were upgraded in EFBs. The concordance rate of 37.2%（16/43）for LGIN,73.2%（82/ 112）for HGIN and 100% （27/27）for EEG was found significantly（P〈0.01）. Compared to the concordant group,the surface nodularity, target biopsy using iodine staining or narrow-band imaging （NBI）or endoscopic ultrasonography（EUS）and Largest diameter of lesion were associated with pathologic upgrade to advanced diseases in ER. [Conclusion]EFB was insufficient for a definitive diagnosis in patients with IEN or EEC. Pathological upgrading of LGIN is common,so biopsy using iodine staining or NBI or EUS is of significant importance to improve diagnostic accuracy for mucosa with larger diameter and nodular lesion.