胃上皮内瘤变内镜活组织检查与内镜切除标本病理结果差异分析  

Histologic diagnostic discrepancy between endoscopic forceps biopsy and endoscopic resection for gastric intraepithelial neoplasia

作　　者：崔建芳[1] 杨爱明[1] 姚方[1] 吴晰[1] 郭涛[1] 周炜洵[2] 陆星华[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化内科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院病理科,北京100730

出　　处：《中华消化内镜杂志》2017年第1期30-33,共4页Chinese Journal of Digestive Endoscopy

基　　金：基金项目：国家科技支撑计划（2013BA101800）

摘　　要：目的分析比较我国胃镜活组织检查（简称活检）和内镜下切除病理诊断胃上皮内瘤变的可靠性。方法回顾性分析2010年1月至2015年3月北京协和医院胃镜活检病理诊断为胃上皮内瘤变的98例患者，包括20例低级别上皮内瘤变（LGIN），65例高级别上皮内瘤变（HGIN）和13例早期胃癌（EGC）。患者均行内镜下切除，结合患者临床资料，对活检病理与内镜下切除病理差异率、临床特征和差异因素进行分析。结果20例活检病理为LGIN的患者，内镜下切除后有12例病理结果较活检病理进展，其中7例HGIN（差异率35．0％，7／20），5例EGC（25．0％，5／20）。活检病理诊断HGIN的65例患者，内镜切除后38例诊断为EGC（58．5％，38／65），4例诊断为LGIN（6．2％，4／65）。13例活检诊断为EGC者切除后病理维持原诊断。活检病理和内镜切除病理诊断的总体差异率为55．1％（54／98）。病变直径〉2cm，病变表面充血是活检和内镜切除病理差异的主要因素（P〈0．05）。结论内镜活检病理诊断胃上皮内瘤变的可靠性欠佳，内镜下切除不仅是治疗胃上皮内瘤变的主要手段，也是明确组织学诊断的一个重要方法。Objective To investigate the histologic diagnostic reliability of endoscopic forceps biopsy （EFB） and endoscopic resection（ER） for gastric intraepithelial neoplasia（GIEN）. Methods A total of 98 patients diagnosed as gastric intraepithelial neoplasia by endoscopic biopsy in Peking Union Medical College Hospital from January 2010 to March 2015 were analyzed retrospectively, including 20 cases of low- grade gastric intraepithelial neoplasia （LGIN）, 65 cases of high-grade gastric intraepithelial neoplasia （HGIN） and 13 cases of early gastric cancer（EGC）. Diagnostic discrepancy, clinical characteristics and influential factors between endoscopic forceps biopsy and endoscopic resection were analysed. Results Of 20 cases of LGIN on EFB, 12 cases were finally diagnosed with ER as a higher grade neoplasia including 7 cases of HGIN （ major histological discrepancy rate 35.0%, 7/20） and 5 cases of EGC （ major histological discrepancy rate 25.0%, 5/20）. Of 65 cases of HGIN on EFB, 38 cases were finally diagnosed as EGC after ER （58.5% ,38/65 ） , 4 as LGIN（ 6. 2% ,4/65 ）. Thirteen EGC patients diagnosed with EFB had the same diagnosis with ER. The overall histological diagnostic discrepancy rate between EFB and ER specimens was 55.1% （54/98） among the enrolled patients. The size more than 2 cm in diameter and the congestive surface were associated with the histological discrepancy between EFB and ER specimens （P 〈 0. 05 ）. Conclusion The reliability of EFB for the definitive diagnosis of gastric intraepithelial neoplasia is not highas ER, which is not only the main treatment but also a precise histological method for diagnosis.

关 键 词：内窥镜检查 活组织检查 诊断 鉴别 胃上皮内瘤变 内镜下切除 

分 类 号：R735.2[医药卫生—肿瘤]