食管高级别上皮内瘤变患者的内镜及组织病理学特征。

Endoscopic and Histopathology Characteristics in Patients with Esophageal High-Grade Intraepithelial Neoplasia.

机构信息

Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

出版信息

Dig Surg. 2019;36(5):384-393. doi: 10.1159/000490112. Epub 2018 Jun 26.

DOI:10.1159/000490112

PMID:29945127

Abstract

BACKGROUND/AIMS: To correlate the endoscopic characteristics with the histopathology of specimens of esophageal high-grade intraepithelial neoplasia obtained by endoscopic submucosal dissection (ESD).

METHODS

This was a retrospective study developed from January 2010 to December 2015. The study included 169 patients who underwent ESD and were diagnosed with esophageal high-grade intraepithelial neoplasia according to endoscopic forceps biopsy, Lugol staining, endoscopic ultrasonography, computed tomography, and Narrow-Band Imaging. The demographic, endoscopic, and histopathologic characteristics were analyzed.

RESULTS

A total of 19 cases (11.2%) had a change in diagnosis after histopathology exam and 16 (9.5%) needed a change in established treatment. An increase in the severity of disease was correlated with a lesion size > 2 cm, less than 4 samples in biopsy, and depressed or excavated patterns (p < 0.05). One hundred forty patients (82.8%) underwent curative resection. Lesions with leukoplakia (p < 0.001) and negative Lugol staining (p = 0.028) were independent risk factor for non-curative resection.

CONCLUSION

This study confirms that lesion size > 2 cm, depressed and excavated patterns, and ≤4 biopsy samples are independent risk factors for histological grade changes compared to pre-endoscopic treatment diagnosis. Similarly, leukoplakia and no Lugol staining of lesions are independent risk factors for non-curative resection.

摘要

背景/目的：将内镜下特征与内镜黏膜下剥离术（ESD）获得的食管高级别上皮内瘤变标本的组织病理学相关联。

方法

这是一项回顾性研究，于 2010 年 1 月至 2015 年 12 月进行。该研究纳入了 169 名经内镜活检钳、卢戈氏染色、内镜超声、计算机断层扫描和窄带成像诊断为食管高级别上皮内瘤变并接受 ESD 治疗的患者。分析了患者的人口统计学、内镜和组织病理学特征。

结果

共有 19 例（11.2%）在组织病理学检查后改变了诊断，16 例（9.5%）需要改变既定治疗方案。疾病严重程度的增加与病变大小>2cm、活检标本数<4 个和凹陷或溃疡型模式相关（p<0.05）。140 例（82.8%）患者行根治性切除。病变为白斑（p<0.001）和卢戈氏染色阴性（p=0.028）是根治性切除失败的独立危险因素。