结直肠肿瘤JNET分型病理改变基础的初步研究

Pathological changes of JNET classification of colorectal tumors

目的探讨结直肠肿瘤JNET分型的病理改变基础。方法收集贵州医科大学附属医院内镜中心2015年1月—2018年6月行窄带光成像放大内镜检查并取得术后病理标本的结直肠肿瘤患者资料,对其内镜JNET分型及病理特征(表面小凹上皮脱落、表面黏膜坏死结构、表面黏膜筛网状结构、纤维组织反应增生、黏膜肌无残留、癌性间质反应)进行回顾性分析。结果共纳入81例结直肠肿瘤患者,病变长径均>1.5 cm,其中内镜治疗74例,外科治疗7例。表面黏膜筛网状结构出现频率为JNET 2A型(2.78%)<3型(20.00%)<2B型(42.80%),组间比较差异均有统计学意义(P均<0.05);纤维组织反应增生、黏膜肌无残留、癌性间质反应出现频率均为2A型、2B型<3型,3型与2A型、2B型比较差异有统计学意义(P均<0.05)。表面小凹上皮脱落、表面黏膜坏死结构在JNET分型与病理诊断相符组与不符组间出现频率差异有统计学意义(P均<0.05)。结论JNET分型中2B型提示病理特征为黏膜表面筛网状结构,3型提示病理特征为纤维组织反应增生,黏膜肌无残留,癌性间质反应。表面小凹上皮脱落、表面黏膜坏死结构可能是影响JNET分型诊断准确性的病理干扰因素。

Objective To investigate the pathological changes of JNET classification of colorectal tumors.Methods Data of patients with colorectal neoplasms who underwent narrow-band imaging combined with magnifying endoscopy,and whose postoperative pathological specimens were obtained at the endoscopy center of the Affiliated Hospital of Guizhou Medical University from January 2015 to June 2018 were analyzed retrospectively.The endoscopic JNET diagnosis and pathological features(surface pit epithelial exfoliation,surface mucosal necrosis structure,surface mucosal ethmoid reticular structure,fibrous tissue reactive hyperplasia,mucosa muscle without residual and carcinomatous interstitial reaction)were analyzed.Results A total of 81 patients with colorectal neoplasms(diameter>1.5 cm)were enrolled with 74 cases receiving endoscopic treatment and seven cases receiving surgical treatment.The frequency of surface mucosal sieve reticular structure in type 3 of JNET(20.00%)was lower than that in type 2B(42.86%),which was in turn higher than that in type 2A(2.78%),with significant differences(P<0.05).The frequencies of fibrous tissue reactive proliferation,no residual mucosal muscles,and carcinomatous interstitial reaction in type 2A and 2B were lower than that of type 3,with significant differences(all P<0.05).There were significant differences in the consistency group and inconsistency group of JNET classification and pathological diagnosis in surface pit epithelial exfoliation and surface mucosal necrosis(all P<0.05).Conclusion Type 2B of JNET classification indicates that the pathological features may be the surface mucosal reticular structure;type 3 indicates reactive hyperplasia of fibrous tissue,no residual mucosal muscles and cancerous interstitial reaction.The exfoliation of the surface pit epithelium and the necrosis of the surface mucosa may be the pathological interference factors affecting the accuracy of JNET classification diagnosis.