Lutz L, Werner M
Institut für Klinische Pathologie, Universitätsklinikum Freiburg, Breisacher Straße 115a, 79106, Freiburg, Deutschland.
Pathologe. 2016 Mar;37(2):193-8; quiz 199-200. doi: 10.1007/s00292-016-0150-3.
In the current S2k guideline for gastroesophageal reflux disease and the new S3 guideline for esophageal cancer, histopathological evaluation of Barrett's esophagus has been revised and supplemented. The histological diagnosis of Barrett's esophagus still requires the proof of a specialized intestinal metaplastic epithelium (columnar epithelium with goblet cells). Barrett mucosa must be classified as negative, unclear/doubtful, and positive concerning the intraepithelial neoplasia (IEN)/dysplasia according to the current WHO guideline. Each IEN should be confirmed by an external second opinion due to poor interobserver variability. The pathological classification is of decisive importance here, since the recommended monitoring intervals are based solely on the ground of proved IEN. Risk factors in endoscopic resection specimens such as depth of infiltration (m1-m4; sm1-sm3; distance in µm); angioinvasion (L, V); grading and lateral/basal resection margin have to be reported. In surgical specimens, the reference of the tumor center to the gastroesophageal junction and in the neoadjuvant situation the tumor regression should be documented.
在当前的胃食管反流病S2k指南和新的食管癌S3指南中，巴雷特食管的组织病理学评估已得到修订和补充。巴雷特食管的组织学诊断仍需要证实存在特殊的肠化生上皮（含杯状细胞的柱状上皮）。根据世界卫生组织现行指南，巴雷特黏膜必须根据上皮内瘤变（IEN）/发育异常情况分为阴性、不明确/可疑和阳性。由于观察者间差异较大，每种IEN都应由外部专家再次确认。此处病理分类至关重要，因为推荐的监测间隔完全基于已证实的IEN。内镜切除标本中的危险因素，如浸润深度（m1 - m4；sm1 - sm3；以微米为单位的距离）、血管侵犯（L、V）、分级以及侧切缘/基底切缘都必须报告。在手术标本中，必须记录肿瘤中心与胃食管交界处的关系，在新辅助治疗情况下，还应记录肿瘤退缩情况。
