内镜下黏膜切除术后病理在早期食管癌及其癌前病变诊断中的价值  

The value of endoscopic mucosal resection in diagnosis of early esophageal cancer and precancerous lesion

作　　者：秦秀敏[1] 贺舜[1] 张月明[1] 薛丽燕[2] 吕宁[2] 王贵齐[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所内镜科,北京100021 [2]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所病理科,北京100021

出　　处：《中华消化内镜杂志》2013年第10期555-559,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨黏膜切除术后病理在早期食管癌及其癌前病变诊断中的价值。方法对行内镜下黏膜切除的217处早期食管癌及其癌前病变的诊断结果进行回顾性总结，比较活检病理诊断与术后病理诊断的差异，分析黏膜切除术后病理对早期食管癌及其癌前病变的诊断价值及存在的局限性。结果活检病理诊断与术后病理诊断相比，41．9％（91／217）诊断不足，15．7％（34／217）诊断过度，42．4％（92／217）诊断相符。相对于活检病理，内镜下黏膜切除术后病理还可对病变的分化程度、浸润深度及是否存在脉管瘤栓进行诊断，为下一步的诊断及治疗提供依据。结论内镜下活检病理对于早期食管癌及其癌前病变病理性质的诊断，存在一定的局限性；而内镜下黏膜切除术后病理诊断可以相对客观地评价病理性质，并为是否需要追加进一步治疗提供相对客观的参考依据；临床诊断及治疗方案需要结合两者共同制定。Objective To investigate the differences of histopathological diagnosis between the endoscopic mucosal resection （EMR） specimens and the biopsy specimens, and to evaluate the value and the limitation of EMR in diagnosis of early esophageal cancers and its precursor lesions. Methods A retrospec- tive analysis on 217 lesions with early esophageal cancers or the precursor lesions treated by EMR was performed. The differences between pathological diagnoses of biopsy and EMR were compared. Results Compared with pathologic diagnosis after EMR, the yield of biopsy consisted of 41.9% （91/217） as under-diag- nosed, 15.7% （ 34/217 ） as over-diagnosed, and 42. 4% （92/217） as consistent. EMR diagnosis also explicated the differentiation, the grade, the invasive depth and the lympho-vascular infiltration of the lesions. Conclusion The endoscopic biopsy diagnosis is limited for the pathological diagnosis of early esophageal cancer and precancerous lesions, while the EMR sample can provide objectiVe diagnosis and provide the guideline for the further treatment.

关 键 词：食管肿瘤 病理学 临床 活组织检查 内镜下黏膜切除术 

分 类 号：R735.1[医药卫生—肿瘤]