食管鳞状上皮内瘤变内镜黏膜下剥离术后病理升级的危险因素分析

Analysis of risk factors for histopathological upgrade after endoscopic submucosal dissection for esophageal squamous intraepithelial neoplasia

目的:分析内镜钳夹活检术(endoscopic forceps biopsy,EFB)提示食管鳞状上皮内瘤变的患者,行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)后组织病理升级的危险因素。方法:回顾性分析2019年11月至2023年5月于川北医学院附属医院就诊的术前EFB提示食管鳞状上皮内瘤变并接受ESD手术的255例患者共255处病灶,按术前EFB与ESD术后病理差异分为升级组(n=123)与未升级组(n=132),采用单因素和多因素Logistic回归分析危险因素。结果:低级别上皮内瘤变(low-grade intraepithelial neoplasia,LGIN)组术前EFB与ESD术后病理一致率为42.9%(18/42),病理升级率为57.1%(24/42);高级别上皮内瘤变(high-grade intraepithelial neoplasia,HGIN)组术前EFB与ESD术后病理一致率为44.1%(94/213),病理升级率为46.0%(98/213),9.9%(21/213)病理降级为LGIN。单因素分析结果提示饮酒史、乳头内毛细血管袢(intrapapillary capillary loop,IPCL)分型、糜烂、溃疡或出血、病变纵向直径≥2 cm、病变累及管腔范围≥1/2差异均具有统计学意义(均P<0.05);多因素分析结果提示B2/B3型IPCL(P=0.001)、病变纵向直径≥2 cm(P=0.014)、病变累及管腔范围≥1/2(P<0.001)是ESD术后病理升级的独立危险因素。结论:对于内镜下提示B2/B3型IPCL、病变纵向直径≥2 cm、病变累及管腔范围≥1/2的病灶,临床医生应高度警惕病灶病变程度被低估的可能性。

Objective:To analyze the risk factors for histopathological upgrade after endoscopic submucosal dissection(ESD)of esophageal squamous intraepithelial neoplasia suggested by endoscopic forceps biopsy(EFB).Methods:We retrospectively analyzed 255 lesions from 255 patients with esophageal squamous intraepithelial neoplasia suggested by EFB who had undergone ESD in the Affiliated Hospital of North Sichuan Medical College between November 2019 and May 2023.Based on the pathological differences between EFB and ESD,they were assigned into upgraded(n=123)and non-upgraded(n=132)groups.Univariate and multivariate Logistic regression analyses were used to analyze the risk factors.Results:The preoperative endoscopic forceps biopsy(EFB)and post-endoscopic submucosal dissection(ESD)pathological concordance rate for low-grade intraepithelial neoplasia(LGIN)group is 42.9%(18/42),with a pathological upgrade rate of 57.1%(24/42).For high-grade intraepithelial neoplasia(HGIN)group,the preoperative EFB and post-ESD pathological concordance rate is 44.1%(94/213),with a pathological upgrade rate of 46.0%(98/213)and 9.9%(21/213)of cases being downgraded to LGIN.The results of the univariate analysis indicate that there is a statistically significant difference in the following factors:alcohol history,intrapapillary capillary loop(IPCL)classification,erosion,ulceration or bleeding,longitudinal diameter of the lesion≥2 cm,and involvement of more than 1/2 of the lumen(P<0.05).Multivariate analysis showed that B2/B3 IPCL(P=0.001),lesion longitudinal diameter≥2cm(P=0.014),and lumen involvement≥1/2(P<0.001)were independent risk factors for pathological upgrade after ESD.Conclusions:Clinicians should be extremely cautious regarding the possibility of underestimating the severity of lesions with endoscopic findings of B2/B3 IPCL,lesion longitudinal diameter≥2cm,and lesion involvement of the lumen≥1/2.