Harrison Rebecca, Perry Ian, Haddadin William, McDonald Stuart, Bryan Richard, Abrams Keith, Sampliner Richard, Talley Nicholas J, Moayyedi Paul, Jankowski Janusz A
Digestive Diseases Center, University Hospitals of Leicester, Leicester UK.
Am J Gastroenterol. 2007 Jun;102(6):1154-61. doi: 10.1111/j.1572-0241.2007.01230.x. Epub 2007 Apr 13.
Intestinal metaplasia (IM) and dysplasia in Barrett's esophagus are recognized surrogates for esophageal adenocarcinoma risk. While few would argue with the "hunt for dysplasia," there is a divide regarding the usefulness of the histological confirmation of intestinal metaplasia in endoscopically apparent long segment Barrett's esophagus. We aimed to assess the frequency of intestinal metaplasia in 125 consecutive patients with columnar-lined esophagus and to determine the optimal biopsy protocol to detect intestinal metaplasia.
Two-hundred ninety-six endoscopies were performed over a 4-yr period in Barrett's esophagus segments of mean length 4 cm (range 1-11 cm) at a single center and the resulting biopsies were analyzed retrospectively. Biopsies were all processed with routine hematoxylin and eosin (H&E) staining, and a subset (N=92) was subject to alcian blue/periodic-acid Schiff staining.
Using H&E staining, we found that the optimum number of biopsies to diagnose intestinal metaplasia was 8 per endoscopy, mean 67.9% endoscopies having intestinal metaplasia. In contrast, if only four were taken the yield was 34.7% with intestinal metaplasia. Unless more than 16 biopsies were taken (100% yield of intestinal metaplasia), no additional significant detection was achieved. Using additional alcian blue/periodic-acid Schiff staining only had a marginal benefit, with 5.4% of new cases of intestinal metaplasia being identified. There is a proximal cephalo-caudal gradient of intestinal metaplasia, especially with increased chronological age, but doing repeat endoscopies on patients did not increase the detection of intestinal metaplasia.
The data suggest that at least 8 random biopsies is the minimum to be taken and analyzed with conventional H&E staining to diagnose benign intestinal metaplasia. Taking more biopsies did not statistically increase the diagnosis of intestinal metaplasia except when greater than 16 were taken when 100% yield was obtained.
巴雷特食管中的肠化生（IM）和发育异常被认为是食管腺癌风险的替代指标。虽然很少有人会反对“筛查发育异常”，但对于在内镜下可见的长段巴雷特食管中肠化生的组织学确认的有用性存在分歧。我们旨在评估125例连续性柱状上皮食管患者的肠化生频率，并确定检测肠化生的最佳活检方案。
在一个中心，于4年期间对平均长度为4 cm（范围1 - 11 cm）的巴雷特食管段进行了296次内镜检查，并对所得活检组织进行回顾性分析。所有活检组织均采用常规苏木精和伊红（H&E）染色处理，一部分（N = 92）进行了阿尔辛蓝/过碘酸希夫染色。
使用H&E染色，我们发现诊断肠化生的最佳活检数量为每次内镜检查8块，平均67.9%的内镜检查存在肠化生。相比之下，如果仅取4块活检组织，肠化生的检出率为34.7%。除非取超过16块活检组织（肠化生检出率达100%），否则不会有额外的显著检出。使用额外的阿尔辛蓝/过碘酸希夫染色仅有边际效益，仅识别出5.4%的肠化生新病例。肠化生存在近端头 - 尾梯度，尤其是随着年龄增长，但对患者进行重复内镜检查并未增加肠化生的检出率。
数据表明，至少8块随机活检组织是采用传统H&E染色诊断良性肠化生时需获取并分析的最少数量。除了取超过16块活检组织可获得100%的检出率外，取更多活检组织在统计学上并未增加肠化生的诊断率。
