Sandler R S, Cummings M S, Keku T O, Terse A, Mehta N
Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina at Chapel Hill, 27514, USA.
Cancer Epidemiol Biomarkers Prev. 2000 Oct;9(10):1123-5.
The performance of various measures of rectal mucosal proliferation has been evaluated in the literature, but the performance of the forceps used to obtain the tissue has received little attention. We used data from two large studies of proliferation at a single institution to compare reusable and disposable endoscopic forceps. Endoscopic pinch biopsies were taken 10 cm from the anal verge using either reusable or disposable, oval-cupped, sheathed forceps. The specimens were fixed, embedded, and sectioned, taking care to orient the specimens longitudinally. Five sections were placed on each slide. We determined how many slides did not contain eight scorable crypts (inadequate) and how many sections were necessary to identify eight complete crypts. There were 395 subjects who had biopsies taken with reusable forceps and 185 subjects who had biopsies taken with disposable forceps. The specimens were inadequate in 27.6% of the reusable forceps specimens versus 2.7% of the disposable forceps (P < 0.0001). The mean number of tissue sections necessary to identify eight scorable crypts for the reusable forceps was 3.82 (SD, 0.87) compared with 3.17 (SD, 0.83) for disposable forceps (P = 0.0001). The specimens taken with the disposable forceps were better, probably because the forceps were sharper. We believe that the better quality of the specimens and the sterility justify the higher cost of disposable forceps. We would urge investigators in proliferation studies to evaluate the biopsy equipment as carefully as they evaluate other aspects of their methods.
文献中已对直肠黏膜增殖的各种测量方法的性能进行了评估，但用于获取组织的钳子的性能却很少受到关注。我们利用来自同一机构的两项关于增殖的大型研究的数据，比较了可重复使用和一次性使用的内镜钳子。使用可重复使用或一次性的椭圆形杯状带鞘钳子，在距肛门边缘10厘米处进行内镜夹取活检。标本经固定、包埋和切片，注意将标本纵向定位。每张载玻片放置五个切片。我们确定有多少载玻片不包含八个可评分的隐窝（不充分），以及识别八个完整隐窝需要多少切片。有395名受试者使用可重复使用的钳子进行活检，185名受试者使用一次性钳子进行活检。可重复使用钳子的标本中有27.6%不充分，而一次性钳子的标本中这一比例为2.7%（P < 0.0001）。识别可重复使用钳子的八个可评分隐窝所需的组织切片平均数为3.82（标准差为0.87），而一次性钳子为3.17（标准差为0.83）（P = 0.0001）。使用一次性钳子获取的标本更好，可能是因为钳子更锋利。我们认为，标本质量更好以及无菌性证明了一次性钳子成本更高是合理的。我们敦促增殖研究的研究者在评估活检设备时要像评估其方法的其他方面一样仔细。
