Peters Femke P, Brakenhoff Klasina P M, Curvers Wouter L, Rosmolen Wilda D, Fockens Paul, ten Kate Fiebo J W, Krishnadath Kausilia K, Bergman Jacques J G H M
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Gastrointest Endosc. 2008 Apr;67(4):604-9. doi: 10.1016/j.gie.2007.08.039. Epub 2007 Dec 26.
Evidence-based selection criteria for endoscopic resection (ER) of Barrett's neoplasia are scarce.
To study the histopathology of ER specimens of Barrett's neoplasia and correlate this with endoscopic characteristics to make recommendations for patient management. DESIGN, SETTING, INTERVENTIONS: Histology and correlating endoscopy reports of specimens obtained at 293 consecutive ERs performed at a Dutch tertiary referral center between 2000 and 2006 were reviewed.
Histologic findings in ER specimens and their relation with endoscopic characteristics.
A total of 150 ERs were performed for focal lesions: 16% type 0-I, 23% 0-IIa, 7% 0-IIb, 3% 0-IIc, 9% 0-IIa-IIb, and 42% 0-IIa-IIc; and 143 for flat mucosa. Histology revealed no dysplasia in 57 ERs, low-grade intraepithelial neoplasia in 52, high-grade intraepithelial neoplasia in 104, T1m in 61, and T1sm in 17; in two cancers, infiltration depth was not assessable because of artifacts. Type 0-I and 0-IIc lesions significantly more often penetrated the submucosa (P = .009): 60% were G1 cancers, 23% were G2 cancers, and 18% were G3 cancers. G2-G3 cancers significantly more often invaded the submucosa (P < .001) or had positive vertical margins (P = .015). Histology of ER specimens led to a change in diagnosis in 49% of the focal lesions and a relevant change in treatment policy in 30%.
A retrospective study.
ER is a valuable diagnostic tool that frequently leads to a change in treatment policy. Most endoscopically resected early Barrett's neoplasia are 0-II type, G1 mucosal neoplasia. Submucosal infiltration is more often encountered in type 0-I and 0-IIc lesions and in G2-G3 cancers.
巴雷特肿瘤内镜切除术（ER）的循证选择标准稀缺。
研究巴雷特肿瘤ER标本的组织病理学，并将其与内镜特征相关联，为患者管理提供建议。
设计、设置、干预措施：回顾了2000年至2006年在一家荷兰三级转诊中心连续进行的293例ER所获取标本的组织学及相关内镜报告。
ER标本的组织学发现及其与内镜特征的关系。
共对局灶性病变进行了150例ER：0-I型占16%，0-IIa型占23%，0-IIb型占7%，0-IIc型占3%，0-IIa-IIb型占9%，0-IIa-IIc型占42%；对扁平黏膜进行了143例ER。组织学检查显示，57例ER标本无发育异常，52例为低级别上皮内瘤变，104例为高级别上皮内瘤变，61例为T1m，17例为T1sm；在2例癌症中，由于人为因素无法评估浸润深度。0-I型和0-IIc型病变穿透黏膜下层的情况明显更常见（P = 0.009）：60%为G1癌，23%为G2癌，18%为G3癌。G2-G3癌侵犯黏膜下层（P < 0.001）或垂直切缘阳性（P = 0.015）的情况明显更常见。ER标本的组织学检查导致49%的局灶性病变诊断改变，30%的治疗策略发生相关改变。
一项回顾性研究。
ER是一种有价值的诊断工具，经常导致治疗策略的改变。大多数经内镜切除的早期巴雷特肿瘤为0-II型，G1黏膜肿瘤。0-I型和0-IIc型病变以及G2-G3癌更常出现黏膜下层浸润。
