内镜活检对胃癌组织学分类术前诊断的价值

Value of endoscopic biopsy in preoperative histologic classification of gastric carcinoma

目的探讨内镜活检对胃癌组织学分类术前诊断的价值。方法术前对141例胃癌患者的内镜活检标本分别根据Lauren分类和世界卫生组织(WHO)分类判断组织学分类,并与手术标本结果对照。结果内镜活检对胃癌Lauren分类术前诊断的准确率为76.6%,对肠型胃癌诊断的敏感性和特异性分别为85.4%和80.6%,而对弥漫型胃癌则分别为82.7%和80.3%。在59例术前诊断为肠型胃癌的病例中,18例(30.5%)在手术标本中呈弥漫性生长;而在75例术前诊断为弥漫型胃癌的病例中,仅6例(8.0%)术后诊断为肠型胃癌。内镜活检对胃癌WHO分类术前诊断的准确率为87.2%,其中对乳头状/管状腺癌、黏液腺癌和印戒细胞癌的敏感性分别为91.9%、33.3%和66.7%。结论内镜活检对胃癌组织学分类的术前诊断具有较高的临床应用价值。

Objective To explore the clinical significance of endoscopic biopsy in the preoperative histologic classification of gastric carcinoma. Methods The histologic classification of 141 patients with gastric carcinoma was preoperatively diagnosed by endoscopic biopsy, according to Lauren classification and World Health Organization (WHO) classification,then compared with postoperative pathological results. Results The accuracy of preoperative endoscopic biopsy for Lauren classification of gastric carcinoma was 76 6%. The sensitivity and specificity was 85 4%and 80 6%for intestinal type, and 82 7%and 80 3%for diffuse type respectively. Among 59 patients with preoperative diagnosis of intestinal type, 18 patients (30 5%) exhibited a diffuse growth pattern in the surgical specimens. Among 75 patients with preoperative diagnosis of diffuse type, only 6 patients (8 0%) were postoperatively diagnosed as intestinal type. The accuracy of endoscopic biopsy for WHO classification of gastric carcinoma was 87 2%, and the sensitivity for papillary/tubular adenocarcinoma, mucinous adenocarcinoma and signet ring cell carcinoma was 91 9%, 33 3%, and 66 7%respectively. Conclusion Endoscopic biopsy may have great clinical importance in the preoperative diagnosis of histologic classification of gastric carcinoma.