Goldstein N S, Watts J C, Neill J S, Vogel L M, Barkel D, Kadro O, Priest S, Klein S
Department of Anatomic Pathology, William Beaumont Hospital, 3601 W Thirteen Miles Rd, Royal Oak, MI 48073, USA.
Am J Clin Pathol. 2001 Mar;115(3):356-61. doi: 10.1309/0KPE-1RG6-KA78-R49Y.
We examined diminutive colonic polyps to identify relationships between thermal electrocoagulation or resection trauma cytologic artifacts, type of thermal electrocoagulation, polyp size, and the interobserver variation among 3 pathologists. The 3 pathologists independently evaluated 119 colonic polyps 5 mm or less in maximum dimension for diagnosis and degree of thermal electrocoagulation or resection trauma cytologic artifacts. The maximum dimension of the polyps and type of thermal electrocoagulation were recorded. The average percentage of polyps in which a definitive diagnosis could not be made because of cytologic artifacts was 16.5% (range, 11.8%-19.3%). Decreasing polyp size was associated linearly with the inability to make a definitive diagnosis owing to cytologic artifacts. Polyps smaller than 2 mm significantly more often could not be definitively diagnosed by at least 1 pathologist owing to cytologic artifacts, including some polyps that were excised without thermal electrocautery. Interobserver variation increased with decreasing polyp dimension. Two millimeters seems to represent a cut point, below which the likelihood that a definitive diagnosis can be made can be increased if thermal electrocoagulation is used. This small size seems to make them especially susceptible to cytologically injurious forces.
我们检查了微小的结肠息肉，以确定热电凝或切除创伤细胞学假象、热电凝类型、息肉大小以及3位病理学家之间的观察者间差异之间的关系。这3位病理学家独立评估了119个最大直径为5毫米或更小的结肠息肉，以诊断热电凝或切除创伤细胞学假象的程度。记录息肉的最大直径和热电凝类型。由于细胞学假象而无法做出明确诊断的息肉平均百分比为16.5%（范围为11.8%-19.3%）。息肉大小的减小与因细胞学假象而无法做出明确诊断呈线性相关。小于2毫米的息肉由于细胞学假象，至少有1位病理学家更常无法做出明确诊断，包括一些未进行热电灼切除的息肉。观察者间差异随着息肉尺寸的减小而增加。2毫米似乎是一个临界点，低于该点，如果使用热电凝，做出明确诊断的可能性会增加。这种小尺寸似乎使它们特别容易受到细胞学损伤力的影响。
