食管低级别上皮内瘤变的内镜切除组织病理升级的危险因素分析

Risk Factors for Missed Diagnosis of Esophageal Low-grade Intraepithelial Neoplasia in Endoscopic Forceps Biopsy Compared with Endoscopic Submucosal Dissection

目的探讨活检为食管低级别上皮内瘤变(LGIN)内镜下切除组织病理升级的危险因素。方法纳入2013年11月至2018年7月内镜下病变组织活检诊断为食管LGIN、并在我院消化内镜中心行内镜下切除病变组织的148例患者,按内镜切除术后是否发生病理升级分为病理升级组(n=77)及病理未升级组(n=71),采用单因素及多因素分析术后发生病理升级的危险因素。结果患者年龄(59.95±7.75)岁,男性占67.57%(100/148);病变位于食管中段(99例)和下段(38例)居多;内镜下病变呈凹陷为主(72例);病变整块切除率99.32%(147/148);77例(52.03%)发生病理升级,其中33例(22.3%)术后病理升级为高级别上皮内瘤变,25例(16.9%)术后病理升级为原位癌,19例(12.8%)升级为浅表食管鳞癌。单因素分析结果提示病变环周≥1/2周、病变纵经≥3cm、超声内镜黏膜下层浸润、内镜下表现为凹陷为主型及病变黏膜发红是LGIN术后发生病理升级的危险因素;多因素分析结果提示病变黏膜发红及病变纵径≥3cm是病理升级的独立危险因素。结论对于活检诊断为LGIN的食管病灶,若病变黏膜发红、病变纵径≥3cm,临床医生应高度警惕病灶病变程度被低估的可能性。

Objective To investigate the risk factors for pathological upgrading after endoscopic treatment of esophageal lesions which confirmed to be low-grade intraepithelial neoplasia （LGIN） by preoperative biopsy. Methods A total of 148 patients who were confirmed to be LGIN in preoperative forceps underwent further endoscopic resection between November 2013 and July 2018. According to the final pathological results after endoscopic treatment, they were divided into pathological upgrading group and pathological non-upgrading group, and their clinicopathological characteristics were analyzed and compared through univariate and multivariate analysis. Results The average age of the patients was （59.95±7.75） years old and the percent of male patients was 67.57% （100/148）. Most lesions were located in the middle esophagus （99 cases） and lower esophagus （38 cases）. Endoscopic gross type was mainly depressed type （72 cases）. The en-bloc resection rate was 99.32% （147/148）. Among the patients （77, 52.03%） who had pathological upgrading, 33 （22.3%） cases were HGIN, 25 （16.9%） cases were in-situ cancer, and 19 （12.8%） cases were superficial esophageal squamous cell carcinoma. Univariate analysis showed that circumferential extent （≥1/2）, longitudinal diameter （≥3 , submucosa involvement found by endoscopic ultrasongraphy, depressed gross type and redness of lesion mucosa were risk factors for postoperative pathological upgrading. Multivariate analysis indicated that the redness of the lesion mucosa and longitudinal diameter （≥3 of the lesion were independent risk factors for pathological upgrading. Conclusion For esophageal lesions diagnosed by biopsy as LGIN, clinicians should be highly alert to the pathological underestimate if the lesion surface is reddened and its longitudinal diameter is greater than 3 cm.