食管癌前病变及早期食管癌黏膜切除术前后病理诊断的对比分析  

Pathological Diagnosis before and after Mucosal Resection for Early Esophageal Cancer and Its Precancerous Lesions: A Comparative Analysis

作　　者：宋钰[1] 罗静[1] 张渊 徐德[1] 陈秋余 Song Yu;Luo Jing;Zhang Yuan;Xu De;Chen Qiuyu(Department of pathology,Bazhong Central Hospital,Bazhong 636600,Sichuan,China)

机构地区：[1]巴中市中心医院病理科,四川巴中636600

出　　处：《肿瘤预防与治疗》2018年第4期263-267,共5页Journal of Cancer Control And Treatment

基　　金："十一五"国家科技支撑计划(编号:2006BAI02A15)

摘　　要：目的:分析黏膜切除术前、后病理诊断符合率,探讨黏膜切除术后病理在食管癌前病变及早期食管癌诊断中的价值,为食管癌的早期诊断及治疗提供相关依据。方法:回顾性收集2013年1月至2017年6月巴中市中心医院收治100例行内镜下黏膜切除术患者,比较术前活检病理诊断与术后病理诊断的一致率及差异性,分析黏膜切除术后病理对食管癌前病变及早期食管癌的诊断价值。结果:活检病理与术后病理诊断符合率为42.06%(45/107),诊断不足(病情被低估)率为41.12%(44/107),诊断过度(病情被高估)率为16.82%(18/107)。轻度异型增生诊断符合率为10%(1/10),诊断不足率为90%(9/10);中度异型增生诊断符合率为17.65%(3/17),诊断不足率为23.53%(4/17),诊断过度率为58.82%(10/17);重度异型增生诊断符合率为38.98%(23/59),诊断不足率为90%(11/59),诊断过度率为18.64%(25/59);早期浸润癌诊断符合率为85.71%(18/21),诊断过度率为14.29%(3/21)。重度异型增生和早期浸润癌患者的平均最大病变直径分别高于轻度异型增生组,早期浸润癌患者的平均最大病变直径高于中度异型增生组,差异有统计学意义(P<0.0083)。结论:内镜下黏膜切除术后病理诊断食管癌前病变及早期食管癌病变性质的准确性更高,但鉴于食管癌癌前病变及早期食管癌病理过程及形态的复杂性,在内镜活检结合术后病理诊断的同时,应参考内镜下表现来制定合理的临床诊疗方案。Objective： To analyze the coincidence rate of pathological diagnosis before and after mucosal resection,and to investigate the value of pathological diagnosis after mucosal resection for early esophageal cancer and its precancerous lesions,so as to provide the basis for the early diagnosis and treatment of esophageal cancer. Methods： A total of 100 patients undergone endoscopic mucosal resection were collected retrospectively from January 2013 to June 2017. The coincidence rates of and differences between preoperative biopsy and postoperative pathological diagnosis were compared. Results： The coincidence rate of biopsy pathology and postoperative pathological diagnosis was 42. 06%（ 45/107）. The underdiagnosis rate（ condition underestimated） was 41. 12%（ 44/107）. And the overdiagnosis rate（ condition overestimated） was 16. 82%（ 18/107）. The diagnosis rate of mild dysplasia was 10%（ 1/10）. The underdiagnosis rate was 90%（ 9/10）. The doagnosis rate of moderate dysplasia was 17. 65%（ 3/17）. The underdiagnosis rate was 23. 53%（ 4/17）.The overdiagnosis rate was 58. 82%（ 10/17）. The diagnosis rate of severe dysplasia was 38. 98%（ 23/59）. The underdiagnosis rate was 90%（ 11/59）. The overdiagnosis rate was18. 64 %（ 25/59）. The coincidence rate of early invasive carcinoma was 85. 71%（ 18/21）,and the rate of overdiagnosis was 14. 29%（ 3/21）. The mean maximum lesion diameters of patients with severe dysplasia and early invasive carcinoma were significantly higher than those with mild dysplasia. And the mean maximum lesion diameters of patients with early invasive carcinoma were significantly higher than those with moderate dysplasia（ P 〈0. 0083）. Conclusion：Pathological diagnosis of early esophageal cancer and its precancerous lesions after endoscopic mucosal resection is comparaytively accurate. But given the complexity of pathological process and morphology of early esophageal cancer and its precancerous lesions,post-pathological diagnosis should be

关 键 词：早期食管癌 癌前病变 内镜下黏膜切除术 病理 

分 类 号：R735.1[医药卫生—肿瘤]