60例胃内镜下黏膜剥离术标本胃异型增生/早期癌的病理学观察——病理诊断差异的原因探讨  

Discrepancies in pathologic evaluation of dyaplasia/early cancer in 60 gastric endoscopic submucosal dissection specimens

作　　者：陈光勇[1] 张澍田[2] 石晓燕[1] 周小鸽[1] 李鹏[2] 冀明[2] 黄受方[1] 

机构地区：[1]首都医科大学附属北京友谊医院病理科,100050 [2]首都医科大学附属北京友谊医院消化内科北京市消化疾病中心,100050

出　　处：《中华病理学杂志》2015年第1期21-26,共6页Chinese Journal of Pathology

摘　　要：目的 通过对胃黏膜内镜下剥离术标本胃异型增生/早期癌的病理学观察,探讨病理诊断差异的原因及应对方法.方法 采用目前通用的胃黏膜上皮肿瘤性病变的三个分类系统及诊断标准,即西方标准、日本标准以及2000年Vienna/WHO分类,对60例胃内镜下黏膜剥离术标本分别作胃异型增生/早期癌的病理学诊断,并比较各诊断结果的差异.结果 按照西方标准诊断为低级别上皮内瘤变的17例中,按照日本的诊断标准其中15例诊断为腺瘤.按照日本标准诊断胃黏膜内癌43例,而根据西方标准,其中只有23例诊断为黏膜内癌.根据西方标准和日本标准,对低级别上皮内瘤变/腺瘤的病理学诊断基本一致,但在胃早期癌的病理学诊断上存在明显差别.结论 胃异型增生/早期癌的病理诊断差异的原因是由于使用了不同的病理诊断系统及诊断标准,为便于临床和病理沟通,我们采用分别以Vienna/WHO分类诊断系统（包括西方标准）为主,并附加日本病理诊断系统的病理报告模式.Objective To study the reasons for the discrepancies in pathologic diagnosis of gastric dysplasia / early cancer in endoscopic submucosal dissection （ESD） specimens,and how to cope with the discrepancies.Methods The pathologic diagnoses in 60 cases of ESD specimens according to the three currently used classification systems （namely Western criteria,Japanese criteria and Vienna classification） were compared.The diagnostic discrepancies were analyzed.Results Fifteen of the 17 cases diagnosed as low-grade intraepithelial neoplasia according to the Western criteria were revised as adenoma by the Japanese criteria.Amongst the 43 cases of gastric intramucosal adenocarcinoma diagnosed according to the Japanese criteria,23 cases had concordant diagnosis by the Western criteria.While the diagnosis of low-grade intraepithelial neoplasia/adenoma was basically similar irrespective of classification system used,there were significant differences in the interpretation of gastric early cancer.Conclusions The diagnostic discrepancies in the gastric dysplasia/early cancer are mainly related to the morphologic criteria applied in different classifications.In order to facilitate clinical and pathologic communication,a consensus using Vienna/WHO classifications,supplemented with Japanese system,is desirable.

关 键 词：胃粘膜 胃疾病 国际疾病分类法 诊断 鉴别 

分 类 号：R735.2[医药卫生—肿瘤]