Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2012 Jan;27(1):36-9. doi: 10.3346/jkms.2012.27.1.36. Epub 2011 Dec 19.
Endoscopic biopsy is necessary to confirm a histopathologic diagnosis. Currently, 6 to 8 biopsies are recommended for diagnosis of a suspected malignant lesion. However, multiple biopsies may result in several problems, such as an increased risk of bleeding, procedure prolongation, and increased workload to pathologists. The aim of this study was to clarify the optimal number of endoscopic biopsy specimens required in diagnosis of advanced gastrointestinal cancer. Patients who were diagnosed with advanced gastrointestinal cancer during endoscopy were included. Five specimens were obtained sequentially from viable tissue of the cancer margin. Experienced pathologists evaluated each specimen and provided diagnoses. A total of 91 patients were enrolled. Fifty-nine subjects had advanced gastric cancer, and 32 had advanced colon cancer. Positive diagnosis rates of the first, second, and third advanced gastric cancer specimens were 81.3%, 94.9%, and 98.3%, respectively, while positive diagnosis rates of advanced colon cancer specimens were 78.1%, 87.5%, and 93.8%. Further biopsies did not increase positive diagnosis cumulative rates. This study demonstrated that three specimens were sufficient to make correct pathologic diagnoses in advanced gastrointestinal cancer. Therefore, we recommend 3 or 4 biopsies from viable tissue in advanced gastrointestinal cancer to make a pathologic diagnosis during endoscopy.
内镜活检对于确认组织病理学诊断是必要的。目前，建议对疑似恶性病变进行 6 至 8 次活检以明确诊断。然而，多次活检可能会导致一些问题，例如出血风险增加、手术时间延长以及病理学家工作量增加。本研究旨在阐明诊断晚期胃肠道癌所需的最佳内镜活检标本数量。纳入了在内镜检查中诊断为晚期胃肠道癌的患者。从癌症边缘的活组织中连续获取 5 个标本。有经验的病理学家评估了每个标本并提供了诊断。共纳入 91 例患者。59 例为晚期胃癌，32 例为晚期结肠癌。第一、第二和第三个晚期胃癌标本的阳性诊断率分别为 81.3%、94.9%和 98.3%，而晚期结肠癌标本的阳性诊断率分别为 78.1%、87.5%和 93.8%。进一步的活检并未增加阳性诊断累积率。本研究表明，对于晚期胃肠道癌，进行 3 次或 4 次活检即可获得正确的病理诊断。因此，我们建议在晚期胃肠道癌的内镜检查中，从活组织中进行 3 或 4 次活检以进行病理诊断。
