Yamada Takayoshi, Tamura Satoru, Onishi Saburo, Hiroi Makoto
Department of Gastroenterology and Hepatology, Kochi Medical School, Nankoku, Kochi, Japan.
Dig Dis Sci. 2009 Sep;54(9):2002-8. doi: 10.1007/s10620-008-0573-7. Epub 2008 Nov 27.
Having noted a discrepancy between endoscopic and histopathological diagnoses in cases of minute adenomas of the colon, a prospective study was designed to clarify which is appropriate, magnifying chromoendoscopy or histopathology of a specimen obtained by biopsy forceps. A total of 208 patients comprised the study population. The endoscopic diagnoses were performed with magnifying colonoscopies. We separated the detected lesions with type III(L) pit pattern following Kudo's classification into two groups at random: in group A (n = 104) resected specimens were fixed with 20% buffered formalin without being flattened, whereas in group B (n = 104) the resected specimens were flattened using forceps before fixation and the specimens were cut under observation of their surface structure with stereomicroscopy. Comparison of the initial diagnoses between groups A and B showed that a total of 84.6% (88/104) of the lesions were diagnosed to be tubular adenomas histopathologically in group A, compared with 100% (104/104) in group B (P < 0.0001). Results for comparison of the secondary diagnoses between group A and group B showed that 14 of the 16 lesions were diagnosed as tubular adenomas histopathologically. Thereafter, 98.1% (102/104) of the lesions were diagnosed to be tubular adenomas histopathologically in group A (P = 0.4976). In conclusion, high-resolution magnifying chromoendoscopy is an appropriate procedure for the diagnosis of minute adenomas in comparison with histopathology of specimens obtained by biopsy forceps in this prospective study.
鉴于在结肠微小腺瘤病例中内镜诊断与组织病理学诊断存在差异，我们设计了一项前瞻性研究，以明确放大色素内镜检查和活检钳获取标本的组织病理学检查哪种方法更合适。共有208例患者纳入研究人群。内镜诊断采用放大结肠镜检查。我们按照工藤分类法将检测到的具有III型（L）凹坑模式的病变随机分为两组：A组（n = 104）切除的标本用20%缓冲福尔马林固定，不进行展平处理；而B组（n = 104）切除的标本在固定前用镊子展平，然后在体视显微镜下观察其表面结构进行切片。A组和B组初始诊断的比较显示，A组共有84.6%（88/104）的病变经组织病理学诊断为管状腺瘤，而B组为100%（104/104）（P < 0.0001）。A组和B组二次诊断比较的结果显示，16个病变中有14个经组织病理学诊断为管状腺瘤。此后，A组98.1%（102/104）的病变经组织病理学诊断为管状腺瘤（P = 0.4976）。总之，在这项前瞻性研究中，与活检钳获取标本的组织病理学检查相比，高分辨率放大色素内镜检查是诊断微小腺瘤的合适方法。
