Vieth M, Seitz G
Institut für Pathologie, Klinikum Bayreuth, 95445 Bayreuth.
Pathologe. 2001 Jan;22(1):62-71. doi: 10.1007/s002920000436.
The most important differential diagnosis of specialized intestinal columnar cell metaplasia (Barrett's-mucosa) is the intestinal metaplasia of the cardia mucosa (possibly caused by Helicobacter infection). Furthermore it happens from time to time that Barrett's regenerative epithelium is overdiagnosed as low-grade dysplasia (unequivocal intraepithelial neoplasia). This might explain the disappearance of many low-grade dysplasias during further follow-up. Mucosal adenocarcinomas are often underdiagnosed as dysplastic lesions. Therefore many authors tried to establish molecular methods for improvement of the diagnostic possibilities. Immunohistochemistry or PCR with p53 and HER 2-neu might give at least some help but a negative reaction does not exclude a neoplasia in every case. The gold standard is careful endoscopy and biopsy taking with good documentation of the endoscopical findings and most important still the routine H&E stain are the only reliable diagnostic tools.
特殊型肠化生（巴雷特黏膜）最重要的鉴别诊断是贲门黏膜的肠化生（可能由幽门螺杆菌感染引起）。此外，巴雷特再生上皮有时会被过度诊断为低级别异型增生（明确的上皮内瘤变）。这或许可以解释为何许多低级别异型增生在进一步随访过程中消失。黏膜腺癌常被漏诊为发育异常性病变。因此，许多作者试图建立分子方法以提高诊断的可能性。免疫组织化学或针对p53和HER 2-neu的聚合酶链反应（PCR）可能至少会有所帮助，但阴性反应并不能在所有情况下排除肿瘤。金标准是仔细的内镜检查和活检，并对内镜检查结果进行良好记录，而且仍然最重要的是，常规苏木精-伊红染色（H&E）仍是唯一可靠的诊断工具。
