188例侧向发育型肿瘤内镜及临床病理学分析

Endoscopic and clinicopathological analysis of 188 cases of laterally spreading tumor

目的总结并评价结直肠侧向发育型肿瘤(laterally spreading tumor,LST)的内镜及临床病理特征。方法回顾性分析2010年12月至2019年12月首都医科大学附属北京世纪坛医院消化内科经内镜下治疗并诊断为LST的患者,根据LST病变内镜下特点,分为颗粒型LST(granular LST,LST-G)及非颗粒型LST(non-granular LST,LST-NG)两个亚组和四个亚型,总结并分析患者的临床一般资料、内镜下特征、组织病理特征、治疗方法等相关资料。结果(1)内镜下特征:共收集176例LST患者(188处病变),LST-NG亚组病变最多,LST病变直径为(22.48±12.26)mm(10~65 mm),LST-G组病变直径大于LST-NG组(P<0.001);LST-G及LST-NG好发于升结肠,LST-G较LST-NG更好发于直肠(χ^(2)=42.360,P<0.001);NICE分类对非肿瘤性息肉及癌和癌前病变诊断的敏感性为97.9%,特异性为82.6%,Kappa值为0.820(P<0.001),NICE分型与病理金标准具有很高的一致性。(2)病理特征:LST亚组均以管状腺瘤为主,LST-NG的癌变率包括HGIN为41.9%,高于LST-G的16.7%(χ^(2)=14.63,P<0.01);LST亚组间微卫星不稳定状态、p53的表达和Ki-67增殖指数差异均无统计学意义(P>0.05)。(3)治疗方式:结肠病变多选择使用EMR及ESD治疗,直肠病变多选择ESD及手术治疗(χ^(2)=19.596,P<0.01),<20 mm的病变多选用EMR治疗,20~<30 mm的病变多选用ESD治疗,≥30 mm的病变,手术治疗的比例逐渐升高(χ^(2)=102.725,P<0.01)。结论LST的临床特性及内镜下表现存在一定的特殊性,临床应重视识别LST病变,提高LST的检出,并对于不同病变采取合适的治疗方案。

Objective To summarize and evaluate the clinicopathological and endoscopic characteristics of laterally spreading tumor(LST).Methods A retrospective analysis was conducted on patients diagnosed with LST who underwent endoscopic treatment at the Department of Gastroenterology,Beijing Shijitan Hospital,Capital Medical University from Dec.2010 to Dec.2019.Based on the endoscopic characteristics of LST lesions,they were divided into two subgroups and four subtypes.Relevant data such as general clinical data,endoscopic characteristics,histopathological features,and treatment methods were summarized and analyzed.Results(1)Endoscopic features:a total of 176 patients with LST(188 lesions)were collected.The LST-NG subgroup had the highest proportion of lesions.The diameter range of LST lesions was(22.48±12.26)mm(10-65 mm).The LST-G group had a larger lesion diameter than the LST-NG group(P<0.001).LST-G and LST-NG were more common in the ascending colon,while LST-G was more common in the rectum than LST-NG(χ^(2)=42.360,P<0.001).The sensitivity and specificity of NICE classification for the diagnosis of non-neoplastic polyps,cancer and precancerous lesions were 97.9%and 82.6%,respectively,with a Kappa value of 0.820(P<0.001).NICE classification showed high consistency with the pathological gold standard.(2)Pathological features:the LST subgroup was mainly composed of tubular adenomas.The cancer transformation rate of LST-NG(including HGIN)was 41.9%higher than that of LST-G(χ^(2)=14.63,P<0.01).There were no significant differences in microsatellite instability,p53 expression,and Ki-67 proliferation index between LST subgroups(P>0.05).(3)Treatment methods:for colon lesions,EMR and ESD treatment were often chosen.For rectal lesions,ESD and surgical treatment were often chosen(χ^(2)=19.596,P<0.01).For lesions smaller than 20 mm,EMR treatment was often chosen.For lesions larger than 20 mm,ESD treatment was often chosen.For lesions larger than 30 mm,the proportion of surgical treatment gradually increased(χ^(2)=102.725,P<0.01).Conclusion The clinical characteristics and endoscopic manifestations of LST have certain specificity.Clinical attention should be paid to identifying LST lesions,improving LST detection,and adopting appropriate treatment plans for different lesions.