内镜下活检钳活检、内镜黏膜切除术与内镜超声检查在巴雷特食管伴高级别异型增生和早期癌患者中的相关性
Correlation between endoscopic forceps biopsies and endoscopic mucosal resection with endoscopic ultrasound in patients with Barrett's esophagus with high-grade dysplasia and early cancer.
作者信息
Thota Prashanthi N, Sada Alaa, Sanaka Madhusudhan R, Jang Sunguk, Lopez Rocio, Goldblum John R, Liu Xiuli, Dumot John A, Vargo John, Zuccarro Gregory
机构信息
Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA.
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA.
出版信息
Surg Endosc. 2017 Mar;31(3):1336-1341. doi: 10.1007/s00464-016-5117-1. Epub 2016 Jul 21.
BACKGROUND
Patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or intramucosal cancer (IMC) on endoscopic forceps biopsies are referred to endoscopic therapy even though forceps biopsies do not reflect the disease extent accurately. Endoscopic mucosal resection (EMR) and endoscopic ultrasound (EUS) are frequently used for staging prior to endoscopic therapy. Our aims were to evaluate: (1) if endoscopic forceps biopsies correlated with EMR histology in these patients; (2) the utility of EUS compared to EMR; and (3) if accuracy of EUS varied based on grade of differentiation of tumor.
METHODS
This is a retrospective review of patients referred to endoscopic therapy of BE with HGD or early esophageal adenocarcinoma (EAC) who underwent EMR from 2006 to 2011. Age, race, sex, length of Barrett's segment, hiatal hernia size, number of endoscopies and biopsy results and EUS findings were abstracted.
RESULTS
A total of 151 patients underwent EMR. In 50 % (75/151) of patients, EMR histology was consistent with endoscopic forceps biopsy findings. EMR resulted in change in diagnosis with upstaging in 21 % (32/151) and downstaging in 29 % (44/151). In patients with HGD on EMR, EUS staging was T0 in 74.1 % (23/31) but upstaged in 25.8 % (8/31). In patients with IMC on EMR, EUS findings were T1a in 23.6 % (9/38), upstaged in 18.4 % (7/38) and downstaged in 57.8 % (22/38). EUS accurately identified EMR histology in all submucosal cancers. Grade of differentiation was reported in 24 cancers on EMR histology. There was no correlation between grade and EUS staging.
CONCLUSIONS
EUS is of limited utility in accurate staging of BE patients with HGD or early EAC. Endoscopic forceps biopsy correlated with EMR findings in only 50 % of patients. Irrespective of the endoscopic forceps biopsy results, all BE patients with visible lesions should be referred to EMR.
背景
内镜活检显示患有巴雷特食管（BE）且伴有高级别异型增生（HGD）或黏膜内癌（IMC）的患者，即便内镜活检不能准确反映疾病范围，仍会接受内镜治疗。内镜黏膜切除术（EMR）和内镜超声检查（EUS）常用于内镜治疗前的分期。我们的目的是评估：（1）这些患者的内镜活检结果与EMR组织学结果是否相关；（2）与EMR相比，EUS的效用如何；（3）EUS的准确性是否因肿瘤分化程度而异。
方法
这是一项对2006年至2011年间接受EMR的BE伴HGD或早期食管腺癌（EAC）患者进行内镜治疗的回顾性研究。记录患者的年龄、种族、性别、巴雷特段长度、食管裂孔疝大小、内镜检查次数、活检结果以及EUS检查结果。
结果
共有151例患者接受了EMR。50%（75/151）的患者，EMR组织学结果与内镜活检结果一致。EMR导致21%（32/151）的患者诊断改变且分期上调，29%（44/151）的患者分期下调。EMR显示为HGD的患者中，74.1%（23/31）的EUS分期为T0，但25.8%（8/31）的患者分期上调。EMR显示为IMC的患者中，23.6%（9/38）的EUS检查结果为T1a，18.4%（7/38）的患者分期上调，57.8%（22/38）的患者分期下调。EUS能够准确识别所有黏膜下癌的EMR组织学结果。EMR组织学报告中有24例癌症的分化程度。分化程度与EUS分期之间无相关性。
结论
EUS在准确分期BE伴HGD或早期EAC患者方面效用有限。内镜活检结果仅在50%的患者中与EMR结果相关。无论内镜活检结果如何，所有有可见病变的BE患者均应接受EMR治疗。
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