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回顾性研究:与内镜下黏膜剥离术相比,胃上皮常规钳取活检的诊断准确性(符合STROBE标准)

Retrospective study: The diagnostic accuracy of conventional forceps biopsy of gastric epithelial compared to endoscopic submucosal dissection (STROBE compliant).

作者信息

Lu Chao, Lv Xueyou, Lin Yiming, Li Dejian, Chen Lihua, Ji Feng, Li Youming, Yu Chaohui

机构信息

Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

出版信息

Medicine (Baltimore). 2016 Jul;95(30):e4353. doi: 10.1097/MD.0000000000004353.

Abstract

Conventional forceps biopsy (CFB) is the most popular way to screen for gastric epithelial neoplasia (GEN) and adenocarcinoma of gastric epithelium. The aim of this study was to compare the diagnostic accuracy between conventional forceps biopsy and endoscopic submucosal dissection (ESD).Four hundred forty-four patients who finally undertook ESD in our hospital were enrolled from Jan 1, 2009 to Sep 1, 2015. We retrospectively assessed the characteristics of pathological results of CFB and ESD.The concordance rate between CFB and ESD specimens was 68.92% (306/444). Men showed a lower concordance rate (63.61% vs 79.33%; P = 0.001) and concordance patients were younger (P = 0.048). In multivariate analysis, men significantly had a lower concordance rate (coefficient -0.730, P = 0.002) and a higher rate of pathological upgrade (coefficient -0.648, P = 0.015). Locations of CFB did not influence the concordance rate statistically.The concordance rate was relatively high in our hospital. According to our analysis, old men plus gastric fundus or antrum of CFB were strongly suggested to perform ESD if precancerous lesions were found. And young women with low-grade intraepithelial neoplasia could select regular follow-up.

摘要

传统钳取活检(CFB)是筛查胃上皮肿瘤(GEN)和胃上皮腺癌最常用的方法。本研究旨在比较传统钳取活检与内镜黏膜下剥离术(ESD)的诊断准确性。选取2009年1月1日至2015年9月1日期间在我院最终接受ESD治疗的444例患者。我们回顾性评估了CFB和ESD的病理结果特征。CFB与ESD标本的符合率为68.92%(306/444)。男性的符合率较低(63.61%对79.33%;P = 0.001),且符合的患者更年轻(P = 0.048)。多因素分析显示,男性的符合率显著较低(系数 -0.730,P = 0.002),病理升级率较高(系数 -0.648,P = 0.015)。CFB的取材部位对符合率无统计学影响。我院的符合率相对较高。根据我们的分析,若发现癌前病变,强烈建议老年男性加胃底或胃窦CFB患者行ESD。而低级别上皮内瘤变的年轻女性可选择定期随访。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a2fb/5265860/c8aa27610a37/medi-95-e4353-g003.jpg

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