活检标本诊断食管鳞状细胞癌的准确性及影响因素分析

Accuracy and influencing factors of biopsy specimens in the diagnosis of esophageal squamous cell carcinoma

目的探讨活检诊断食管鳞状细胞癌的准确性及影响因素。方法选取2015年1月至2019年5月郑州大学第一附属医院收治的食管鳞状细胞癌患者901例,所有患者均行食管切除手术或内镜黏膜下剥离术(ESD),术前均行内镜活检,以术后标本的病理诊断结果为标准,分析活检标本病理诊断的准确性及影响因素。结果 901例术后确诊为鳞状细胞癌的患者中,术前活检标本诊断鳞状细胞癌785例,诊断符合率为87.1%(785/901),低诊/漏诊率为12.9%(116/901)。内镜取材表浅、取材定位不准确以及表浅型食管癌者,活检诊断食管鳞状细胞癌的低诊/漏诊率较高(P<0.05)。鳞状上皮推挤式的边缘、鳞状上皮原位癌样结构的出现等形态学表现提示可能存在浸润性癌(P<0.05)。有明确内镜诊断的97例低诊/漏诊患者中,内镜诊断癌与术后病理诊断癌的符合率为75.3%(73/97),故内镜诊断对病理诊断具有一定的提示性。结论鳞状上皮推挤式的边缘及鳞状上皮原位癌样结构等形态学表现提示可能存在鳞状细胞癌,病理医师应提高警惕,多结合内镜诊断及表现,给出准确的诊断;活检取材表浅、活检取材定位不准确等因素会增加活检诊断食管鳞状细胞癌的低诊/漏诊率,内镜医师应规范取材、多点取材,从源头避免低诊/漏诊。

Objective To investigate the accuracy and influencing factors of biopsy specimens in the diagnosis of esophageal squamous cell carcinoma.Methods A total of 901 patients with esophageal squamous cell carcinoma admitted to the First Affiliated Hospital of Zhengzhou University from January 2015 to May 2019 were selected.All patients underwent esophagectomy or endoscopic submucosal dissection(ESD),and they experienced endoscopic biopsy before operation.The accuracy and influencing factors of pathological diagnosis of biopsy specimens were analyzed with the pathological diagnosis results of postoperative samples as gold standards.Results Among the 901 cases confirmed as squamous cell carcinoma by postoperative biopsy specimens,785 cases were diagnosed as squamous cell carcinoma by preoperative biopsy,while the diagnostic coincidence rate was 87.1%(785/901),and the low or missed diagnosis rate was 12.9%(116/901).For patients with superficial biopsy materials,inaccurate biopsy material positioning and superficial esophageal cancer,the rate of low or missed diagnosis of esophageal squamous cell carcinoma by biopsy was higher(P<0.05).Morphological manifestations,such as squamous epithelial pushing edge,appearance of squamous epithelial carcinoma-like structures,suggested the possibility of invasive carcinoma(P<0.05).Of the 97 cases of underdiagnosis or missed diagnosis which experienced endoscopic diagnosis,the coincidence rate of endoscopic diagnosis and postoperative pathological diagnosis for cancer was 75.3%(73/97),which suggested that endoscopic diagnosis was suggestive for pathological diagnosis.Conclusions The morphological manifestations,such as squamous epithelial pushing edge and squamous epithelial carcinoma-like structures,suggest the possibility of squamous cell carcinoma.Pathologists should be vigilant for these patients,and make accurate diagnosis by taking endoscopic diagnosis and manifestations into account.Endoscopic physicians should standardize material collection,multi-point material collection,so as to avoid superficial biopsy material acquisition,inaccurate biopsy material positioning,superficial esophageal cancer and other factors that cause underdiagnosis and missed diagnosis of esophageal squamous cell carcinoma.