Prasad Ganapathy A, Buttar Navtej S, Wongkeesong Louis M, Lewis Jason T, Sanderson Schuyler O, Lutzke Lori S, Borkenhagen Lynn S, Wang Kenneth K
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Am J Gastroenterol. 2007 Nov;102(11):2380-6. doi: 10.1111/j.1572-0241.2007.01419.x. Epub 2007 Jul 19.
Although EMR has been used for elimination of neoplasia in BE, the significance of positive carcinoma margins and depth of invasion on endoscopic resection pathology has not been assessed using a valid standard. The aim of this study was to assess the accuracy of tumor staging by EMR using esophagectomy as the standard.
Medical records of patients, who underwent endoscopic resection for esophageal carcinoma or high-grade dysplasia in BE followed by esophagectomy, were reviewed. Data were abstracted from a prospectively maintained EMR database. Endosonography and endoscopic resection were performed by a single experienced endoscopist. Two experienced GI pathologists interpreted all histological results. Standard statistical tests were used to compare continuous and categorical variables.
Twenty-five patients were included in the study. Three patients had mucosal carcinoma and 16 had submucosal carcinoma following endoscopic resection. Surgical pathology staging was consistent with preoperative EMR staging in all patients. No patient with negative mucosal resection margins had residual tumor at the resection site at esophagectomy. In patients with submucosal carcinoma, 8 had residual carcinoma at the EMR site at surgery and 5 patients had metastatic lymphadenopathy.
Tumor staging using EMR pathology is accurate when compared with surgical pathology following esophagectomy. Negative margins on EMR pathology correlate with absence of residual disease at the EMR site at esophagectomy. Submucosal carcinoma on EMR specimens was associated with a high prevalence of residual disease at surgery (50%) and metastatic lymphadenopathy (31%).
虽然内镜黏膜切除术（EMR）已用于消除 Barrett 食管中的肿瘤形成，但尚未使用有效的标准评估内镜切除病理中癌切缘阳性和浸润深度的意义。本研究的目的是以食管切除术为标准评估 EMR 对肿瘤分期的准确性。
回顾了因食管癌或 Barrett 食管高级别异型增生接受内镜切除后再行食管切除术的患者的病历。数据从一个前瞻性维护的 EMR 数据库中提取。内镜超声检查和内镜切除由一位经验丰富的内镜医师进行。两位经验丰富的胃肠病理学家解读所有组织学结果。使用标准统计检验比较连续变量和分类变量。
25 例患者纳入研究。内镜切除后，3 例为黏膜癌，16 例为黏膜下癌。所有患者的手术病理分期与术前 EMR 分期一致。黏膜切除切缘阴性的患者在食管切除术中切除部位均无残留肿瘤。在黏膜下癌患者中，8 例在手术时 EMR 部位有残留癌，5 例有转移性淋巴结病。
与食管切除术后的手术病理相比，使用 EMR 病理进行肿瘤分期是准确的。EMR 病理切缘阴性与食管切除术中 EMR 部位无残留疾病相关。EMR 标本中的黏膜下癌与手术时残留疾病的高发生率（50%）和转移性淋巴结病（31%）相关。
