食管上皮内瘤变术前活检和内镜黏膜下剥离术后病理分析

Pathological of Esophageal Intraepithelial Neoplasia After Preoperative Biopsy and Endoscopic Submucosal Dissection

目的分析食管上皮内瘤变术前活检与内镜黏膜下剥离术(ESD)后病理差异,探讨食管上皮内瘤变术后病理升级的危险因素。方法回顾性分析2016年7月至2022年4月在郑州大学第五附属医院消化内镜中心活检病理诊断为食管低级别上皮内瘤变(LGIN)或高级别上皮内瘤变(HGIN)并接受ESD治疗的119例患者(124个病灶)的临床资料,采用单因素和多因素分析探讨可能引起术后病理升级的危险因素。结果124个病灶中46个活检诊断为LGIN,78个诊断为HGIN。LGIN组中活检与术后病理一致占56.52%(26/46),升级为HGIN或食管鳞状细胞癌(ESCC)分别占36.96%(17/46)和4.35%(2/46),总升级率41.30%(19/46),1例降级为慢性炎症。HGIN组中病理一致占52.56%(41/78),术后升级为ESCC占38.46%(30/78),降级为LGIN占8.97%(7/78)。多因素回归分析结果显示,病变表面发红(P=0.015)、结节样改变(P=0.007)及B型上皮内乳头状毛细血管袢(IPCL)(P=0.018)是LGIN组术后病理升级的危险因素,病变表面发红(P=0.002),结节样改变(P=0.001)是HGIN组术后病理升级的危险因素。结论食管早癌及癌前病变术前活检与ESD术后病理存在差异,白光内镜下病灶表面发红、黏膜呈结节样改变、放大内镜和窄带成像(ME-NBI)观察为B型IPCL的患者,提示其存在术后病理升级的风险,必要时可反复活检或切除ESD以明确病灶性质。

Objective To analyze the pathological differences between preoperative biopsy and endoscopic submucosal dissection(ESD)of esophageal intraepithelial neoplasia,and to explore the risk factors of pathological upgrading after esophageal intraepithelial neoplasia.Methods The clinical data of 119 patients(124 lesions)with esophageal low-grade intraepithelial neoplasia(LGIN)or high-grade intraepithelial neoplasia(HGIN)who underwent biopsy in the digestive endoscopy center of the Fifth Affiliated Hospital of Zhengzhou University from July 2016 to April 2022 and with ESD were analyzed retrospectively.Univariate and multivariate analysis were used to explore the risk factors that may cause postoperative pathological upgrading.Results Among 124 lesions,46 were diagnosed as LGIN and 78 as HGIN by biopsy.In LGIN group,biopsy was consistent with postoperative pathology,accounting for 56.52%(26/46),and upgrading to HGIN or esophageal squamous cell carcinoma(ESCC)accounted for 36.96%(17/46)and 4.35%(2/46),respectively.The total upgrading rate was 41.30%(19/46),and 1 case was degraded to chronic inflammation.In HGIN group,52.56%(41/78)were pathologically consistent,38.46%(30/78)were upgraded to ESCC after operation,and 8.97%(7/78)were degraded to LGIN.Multivariate regression analysis showed that redness of lesion surface(P=0.015),nodular changes(P=0.007)and type B intrapapillary capillary loops(IPCL)(P=0.018)were risk factors for postoperative pathological upgrading in LGIN group,redness of lesion surface(P=0.002)and nodular changes(P=0.001)were risk factors for postoperative pathological upgrading in HGIN group.Conclusion There are differences between preoperative biopsy and postoperative pathology of ESD in early esophageal cancer and precancerous lesions.Patients with type B IPCL observed by magnifying endoscopy and narrow band imaging(ME-NBI)with red lesion surface and nodular mucosa under white light endoscopy suggest that they have the risk of postoperative pathological upgrading.It is necessary to repeated biopsy or ESD resection can be performed to clarify the nature of the lesion.