Dostler I, Ell C, Neuhaus H, Stolte M
Klinikum Kulmbach, Institut für Pathologie.
Z Gastroenterol. 2010 May;48(5):542-5. doi: 10.1055/s-0028-1109937. Epub 2010 May 6.
In view of the rapidly increasing incidence of Barrett's carcinoma, a desirable aim would be to detect intraepithelial neoplasia and mucosal carcinoma via the endoscope. Where something new is growing, it should give rise to visible changes in surface structure, in particular, in the case of the early Barrett's neoplasia. The present study was carried out to investigate this hypothesis.
A total of 600 formalin-fixed endoscopically resected specimens (317 patients) from Barrett's oesophagus were prospectively investigated by stereomicroscopy (magnification up to x 90). The surface structure was classified into regular (finely granulated or ridged gyriform) and irregular (coarsely granulated, polypoid elevated or depressed), and compared with the results of the histological evaluation.
88.5 % of the Barrett's carcinomas, and 76 % and 68 %, respectively, of the cases of high-grade and low-grade intraepithelial neoplasia were associated with an irregular surface structure. However, coarsely granulated mucosal surfaces, reflecting regenerative changes, were also found in 26 % of the cases of Barrett's mucosa without intraepithelial neoplasia.
Despite formalin fixation, 68 - 88.5 % of the cases of early Barrett's neoplasia can be identified by stereo microscopy. This shows that high-resolution videoendoscopy or magnification endoscopy appears to be a highly suitable method for the targeted detection of early Barrett's neoplasia.
鉴于巴雷特食管癌的发病率迅速上升，一个理想的目标是通过内镜检测上皮内瘤变和黏膜癌。在新生长的组织处，其表面结构应会出现可见变化，特别是在早期巴雷特瘤变的情况下。本研究旨在探讨这一假说。
对317例患者的600份经福尔马林固定的巴雷特食管内镜切除标本进行前瞻性立体显微镜检查（放大倍数可达90倍）。将表面结构分为规则型（细颗粒状或脊状回旋形）和不规则型（粗颗粒状、息肉样隆起或凹陷），并与组织学评估结果进行比较。
88.5%的巴雷特癌以及76%和68%的高级别和低级别上皮内瘤变病例与不规则表面结构相关。然而，在26%无上皮内瘤变的巴雷特黏膜病例中也发现了反映再生变化的粗颗粒状黏膜表面。
尽管经过福尔马林固定，68 - 88.5%的早期巴雷特瘤变病例可通过立体显微镜识别。这表明高分辨率视频内镜或放大内镜似乎是靶向检测早期巴雷特瘤变的高度合适方法。
