活检病理为胃黏膜高级别上皮内瘤变漏诊癌变的风险因素分析  

Risk factors for missed diagnosis of high-grade gastric neoplasia

作　　者：姚佳[1] 柴宝[1] 王琳[2] 李丽[2] 原丽莉[1] 

机构地区：[1]山西医学科学院山西大医院消化内科,太原030032 [2]山西医学科学院山西大医院病理科,太原030032

出　　处：《中华消化内镜杂志》2016年第6期353-356,共4页Chinese Journal of Digestive Endoscopy

基　　金：山西省科技攻关项目（20130313021-18）

摘　　要：目的探讨胃黏膜病灶活检病理为高级别上皮内瘤变实则漏诊癌变的内镜下特点相关风险因素。方法回顾性收集2011年11月至2015年4月问43例行ESD切除且术前活检诊断为胃黏膜高级别上皮内瘤变患者的病例资料，根据ESD术后大体标本的病理结果分为高级别上皮内瘤变组（26例）和癌变组（17例），统计分析2组病灶内镜下特点的差异。结果2组在患者年龄（t=6．124，P=0．101）及性别构成（x2=0．189，P=0．663）方面差异均无统计学意义，在病变位置（x2=1．008，P=0．909）、病灶形态（x2=0．537，P=0．765）、病灶表面黏膜结节（x2=0．599，P=0．439）和取活检次数（u=1．833，P=0．591）方面差异亦均无统计学意义。单因素分析提示组间存在差异的病变大小（t=3．324，P=0．016）、病灶表面黏膜充血（x2=11．882，P〈0．001）和病灶表面黏膜溃疡（r=5．635，P=0．018），纳入多因素logistic回归分析后发现病灶≥20mm（OR=2．041，95％CI：1．023—5．682，P〈0．001）和病灶表面黏膜有溃疡（OR=3．764，95％CI：1．223—9．431，P〈0．001）是活检病理为胃黏膜高级别上皮内瘤变易漏诊癌变的独立危险因素。结论对于活检病理提示高级别上皮内瘤变的胃黏膜病灶，如直径I〉20mm或表面黏膜有溃疡，需警惕活检漏诊癌变的可能。但因受限于样本量及回顾性研究的样本选择偏倚，所得风险因素尚不够全面，还需进一步研究来加以完善。Objective To evaluate the potential risk factors for missed diagnosis of gastric high- grade neoplasia（HGN） lesion on the basis of endoscopic features. Methods A total of 43 lesions which were initially diagnosed as HGN without cancer by forceps biopsy and later underwent endoscopic submucosal dissection（ESD） were included from November 2011 to April 2015. According to histology of ESD specimens, they were divided into HGN group and the cancer group, and their endoscopic characteristics were compared. Results There was no significant difference in the age（t = 6. 124, P= 0. 101 ）, gender distribution （X2 =0. 189,P= 0. 663） ,lesion location（X2 = 1. 008 ,P=0. 909） ,lesion morphology（X2 =0. 537 ,P=0. 765）, mucosal nodular lesions surface （X2 = 0. 599, P = 0. 439） or biopsy times （ u = 1. 833, P = 0. 591 ） between the HGN group and cancer group. Univariate analysis showed that there were significant differences in size （t = 3. 324,P= 0. 016）, a red change of the mucosal surface （X2= 11. 882, P〈0. 001 ）and mucosal ulceration （X2= 5. 635, P= 0. 018）between the two groups. In the multivariate analysis, size larger than 20 mm（ OR = 2. 041, 95%CI： 1. 023-5. 682,P〈0. 001） and mucosal ulceration（ OR = 3. 764, 95%CI： 1. 223-9. 431, P〈 0. 001 ） were independent risk factors for the missed diagnosis of cancer on the HGN by forceps biopsy. Conclusion For biopsy-proven HGN gastric mucosa lesions, whose sizes are larger than 20 mm or with superficial mucosal ulcer, we need to alert to the possible missed diagnosis of cancer. Due to the limited sample size and selection bias of retrospective study sample, further researches are still needed.

关 键 词：胃癌 高级别上皮内瘤变 胃镜活检 内镜黏膜下剥离术 

分 类 号：R735.2[医药卫生—肿瘤]