浅表性、非壶腹性十二指肠腺癌的内镜及活检诊断
Endoscopic and biopsy diagnoses of superficial, nonampullary, duodenal adenocarcinomas.
作者信息
Kakushima Naomi, Kanemoto Hideyuki, Sasaki Keiko, Kawata Noboru, Tanaka Masaki, Takizawa Kohei, Imai Kenichiro, Hotta Kinichi, Matsubayashi Hiroyuki, Ono Hiroyuki
机构信息
Naomi Kakushima, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 4118777, Japan.
出版信息
World J Gastroenterol. 2015 May 14;21(18):5560-7. doi: 10.3748/wjg.v21.i18.5560.
AIM
To investigate the accuracy of endoscopic or biopsy diagnoses of superficial nonampullary duodenal epithelial tumors (NADETs).
METHODS
Clinicopathological data were reviewed for 84 superficial NADETs from 74 patients who underwent surgery or endoscopic resection between September 2002 and August 2014 at a single prefectural cancer center. Superficial NADETs were defined as lesions confined to the mucosa or submucosa. Demographic and clinicopathological data were retrieved from charts, endoscopic and pathologic reports. Endoscopic reports included endoscopic diagnosis, location, gross type, diameter, color, and presence or absence of biopsy. Endoscopic diagnoses were made by an endoscopist in charge of the examination before biopsy specimens were obtained. Endoscopic images were obtained using routine, front-view, high-resolution video endoscopy, and chromoendoscopy with indigocarmine was performed for all lesions. Endoscopic images were reviewed by at least two endoscopists to assess endoscopic findings indicative of carcinoma. Preoperative diagnoses based on endoscopy and biopsy findings were compared with histological diagnoses of resected specimens. Sensitivity, specificity, and accuracy were assessed for endoscopic diagnosis and biopsy diagnosis.
RESULTS
The majority (81%) of the lesions were located in the second portion of the duodenum. The median lesion diameter was 14.5 mm according to final histology. Surgery was performed for 49 lesions from 39 patients, and 35 lesions from 35 patients were endoscopically resected. Final histology confirmed 65 carcinomas, 15 adenomas, and 3 hyperplasias. A final diagnosis of duodenal carcinoma was made for 91% (52/57) of the lesions diagnosed as carcinoma by endoscopy and 93% (42/45) of the lesions diagnosed as carcinoma by biopsy. The sensitivity, specificity, and accuracy of endoscopic diagnoses were 80%, 72%, and 78%, respectively, whereas those of biopsy diagnoses were 72%, 80%, and 74%, respectively. Preoperative diagnoses of carcinomas were made in 88% (57/65) of the carcinoma lesions via endoscopy or biopsy. Endoscopic findings associated with carcinoma were red color, depression, and mixed-type morphology.
CONCLUSION
Preoperative endoscopy and biopsy showed similar accuracies in the diagnosis of carcinoma in patients with superficial NADETs.
目的
探讨内镜或活检诊断浅表性非壶腹十二指肠上皮肿瘤（NADETs）的准确性。
方法
回顾了2002年9月至2014年8月期间在一家县级癌症中心接受手术或内镜切除的74例患者的84个浅表性NADETs的临床病理资料。浅表性NADETs定义为局限于黏膜或黏膜下层的病变。从病历、内镜和病理报告中获取人口统计学和临床病理资料。内镜报告包括内镜诊断、位置、大体类型、直径、颜色以及是否进行活检。内镜诊断由负责检查的内镜医师在获取活检标本之前做出。使用常规的前视高分辨率视频内镜获取内镜图像，并对所有病变进行靛胭脂染色内镜检查。至少两名内镜医师对内镜图像进行复查，以评估提示癌的内镜表现。将基于内镜和活检结果的术前诊断与切除标本的组织学诊断进行比较。评估内镜诊断和活检诊断的敏感性、特异性和准确性。
结果
大多数（81%）病变位于十二指肠第二部。根据最终组织学检查，病变的中位直径为14.5毫米。对39例患者的49个病变进行了手术，对35例患者的35个病变进行了内镜切除。最终组织学检查证实有65例癌、15例腺瘤和3例增生。内镜诊断为癌的病变中，91%（52/57）最终诊断为十二指肠癌；活检诊断为癌的病变中，93%（42/45）最终诊断为十二指肠癌。内镜诊断的敏感性、特异性和准确性分别为80%、72%和78%，而活检诊断的敏感性、特异性和准确性分别为72%、80%和74%。通过内镜或活检，88%（57/65）的癌性病变做出了术前诊断。与癌相关的内镜表现为红色、凹陷和混合型形态。
结论
术前内镜检查和活检在浅表性NADETs患者的癌诊断中显示出相似的准确性。
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