180例胃癌术前胃镜病理活检结果及误漏诊因素分析

Analysis of preoperative pathological biopsy and misdiagnosis and missed diagnosis factors in 180 cases of gastric cancer

目的探讨术前胃镜病理活检结果与术后病理的一致性,并对误诊、漏诊原因进行分析。方法选取在医院接受胃切除手术并经术后病理明确诊断的180例胃癌患者作为研究对象,比较术后病理检查与术前胃镜活检结果,并对误诊、漏诊原因进行分析。结果术后病理活检显示,180例中,分化型胃癌160例,分化不良型胃癌20例;黏液腺癌11例(6.10%),管状腺癌57例(31.70%),印戒细胞癌20例(11.10%),乳头状腺癌16例(8.90%),低分化癌76例(42.20%)。术前胃镜病理活检共检出胃癌166例,判定分化型胃癌120(72.29%)例,分化不良型46(27.71%)例;黏液腺癌12(7.20%)例,管状腺癌55例(33.10%),印戒细胞癌23例(13.90%),乳头状腺癌29例(17.50%),低分化腺癌47例(28.30%)。与术后病理活检比较,术前胃镜活检诊断胃癌的符合率为92.22%,对分化程度、病理类型判定的Kappa系数分别为0.694、0.571(P<0.01),一致性良好。结论术前胃镜活检虽具一定取样局限,但其在胃癌诊断、组织分化分类及病理分型上所发挥的临床价值仍不可忽视,临床应重视活检取材及临床经验累积,严格遵循相关操作及取材规范,或能进一步提升术前胃镜活检诊断胃癌的准确率。

Objective To explore the consistency of preoperative pathological biopsy and postoperative pathology, and analyze the causes for misdiagnosis and missed diagnosis. Methods A total of 180 patients who had been suffering gastric cancer and had received gastrectomy and postoperative definitive pathological diagnosis in our hospital were selected as research subjects. The results of postoperative pathological examination and preoperative gastroscopy were compared, and the causes for misdiagnosis and missed diagnosis were analyzed. Results The postoperative pathological biopsy showed that among the 180 cases, there were 160 cases of differentiated gastric cancer and 20 cases of poorly differentiated gastric cancer, including 11 cases of mucinous adenocarcinoma（6.10%）, 57 cases of tubular adenocarcinoma（31.70%）, 20 cases of signet ring cell carcinoma（SRCC）（11.10%）, 16 cases of papillary adenocarcinoma（8.90%）, and 76 cases of low differentiated carcinoma（42.20%）. The preoperative gastroscopy pathological biopsy showed that there were 166 cases of gastric cancer detected, including 120 cases of differentiated gastric cancer（72.29%） and 46 cases of poorly differentiated gastric cancer（27.71%）, among which, there were 12 cases of mucinous adenocarcinoma（7.20%）, 55 cases of tubular adenocarcinoma（33.10%）, 23 cases of signet ring cell carcinoma（SRCC）（13.9%）, 29 cases of papillary adenocarcinoma（17.50%）, and 47 cases of low differentiated carcinoma（28.30%）. Compared with the postoperative pathological biopsy, the coincidence rate of preoperative gastroscopy in the diagnosis of gastric cancer was 92.22%. The Kappa coefficients for differentiation degree and pathological type judgment were 0.694 and 0.571, respectively（P〈0.01）, showing that the consistency was good.Conclusion The preoperative gastroscopy has certain sampling limitations, but its role in the diagnosis of gastric cancer, classification of tissue differentiation and pathological classification should not be ignored. It is necessary to pay attention to the accumulation of biopsy materials and clinical experience and strictly follow the operating rules and sampling standards, so as to improve the accuracy in the diagnosis of gastric cancer by preoperative gastroscopy.