Dry Sarah M, Lewin Klaus J
Department of Pathology, University of California, Los Angeles, USA.
Semin Diagn Pathol. 2002 Feb;19(1):2-11.
Esophageal squamous dysplasia (ESD) appears to be the most important precursor for squamous cell carcinoma (SCC), and this observation is supported by early molecular findings. Pathologists in high incidence areas of the world, such as China, frequently may encounter ESD during surveillance cytology and biopsy screenings of high risk populations. ESD in low risk areas, such as the United States, is more commonly seen in esophagi resected for squamous cell carcinoma. As at other sites, ESD can be graded histologically depending on the thickness of epithelial involvement and cytologically based largely on nuclear size and chromatin features. Most ESD lesions are endoscopically visible, especially if the esophageal mucosa is sprayed with iodine, allowing for directed biopsy. Several studies have shown that important differences in histologic and cytologic diagnosis and grading exist between Western pathologists and those in China or Japan. Despite these findings, the risk of developing invasive SCC is closely correlated to the severity of ESD encountered. Correct recognition of ESD thus is important.
食管鳞状上皮发育异常（ESD）似乎是鳞状细胞癌（SCC）最重要的癌前病变，这一观察结果得到了早期分子研究结果的支持。在世界上食管癌高发地区，如中国，病理学家在对高危人群进行监测细胞学和活检筛查时经常会遇到ESD。在低发地区，如美国，ESD更常见于因鳞状细胞癌而切除的食管中。与其他部位一样，ESD可根据上皮受累的厚度进行组织学分级，细胞学分级主要基于细胞核大小和染色质特征。大多数ESD病变在内镜下可见，尤其是在食管黏膜喷洒碘后，便于进行定向活检。几项研究表明，西方病理学家与中国或日本的病理学家在组织学和细胞学诊断及分级方面存在重要差异。尽管有这些发现，但发生浸润性SCC的风险与所遇到的ESD严重程度密切相关。因此正确识别ESD很重要。
