Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Department of Pathology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Dig Endosc. 2019 Jul;31(4):405-412. doi: 10.1111/den.13355. Epub 2019 Mar 14.
The pathological diagnosis of endoscopically resected early gastric cancer (EGC) is performed by evaluating a few representative sections from the specimen. We aimed to determine whether evaluating twice as many sections as usual by essentially cutting the original sections in half could improve the pathological diagnosis of EGC.
We retrospectively investigated 85 EGC in 82 patients who had undergone endoscopic resection at our hospital from August 2008 to October 2012. EGC without indications of curative resection were excluded. We re-examined the original paraffin blocks after shaving away approximately half their original thickness, and evaluated whether the pathological diagnoses were affected. This technique essentially doubled the number of sections examined.
Ten pathological diagnoses of 68 EGC (14.7%) were changed from curative resection to non-curative resection when we evaluated twice as many sections as in the standard method. The median tumor size was 25 mm in the changed diagnosis group versus 14.5 mm in the no change group (P = 0.03). The univariate analysis also showed that tumor size was a significant predictor of changed diagnosis (P = 0.015). Both the changed diagnosis group and no change group had no recurrence during follow up.
Histological evaluation of twice as many sections as usual changed the initial pathological diagnosis of EGC, although the clinical implication of an additional deeper section was controversial because there was no recurrence. Our analysis also emphasized the importance of detailed histological evaluation to confirm a radical cure in endoscopic resection, especially in the case of larger EGC.
通过评估标本中的几个代表性切片，对内镜切除的早期胃癌（EGC）进行病理诊断。我们旨在确定通过将原始切片基本对半切开来评估两倍于通常数量的切片是否可以改善 EGC 的病理诊断。
我们回顾性调查了 2008 年 8 月至 2012 年 10 月在我院接受内镜切除的 82 例 85 例 EGC 患者。排除无治愈性切除指征的 EGC。我们在刮除大约一半原始厚度后重新检查原始石蜡块，并评估病理诊断是否受到影响。这种技术实质上使检查的切片数量增加了一倍。
当我们评估两倍于标准方法的切片数量时，68 例 EGC（14.7%）中的 10 例病理诊断从治愈性切除改为非治愈性切除。改变诊断组的肿瘤中位数大小为 25mm，而无改变组为 14.5mm（P=0.03）。单因素分析也表明肿瘤大小是改变诊断的一个显著预测因素（P=0.015）。在随访期间，改变诊断组和无改变组均无复发。
评估两倍于通常数量的切片改变了 EGC 的初始病理诊断，尽管增加更深的切片的临床意义存在争议，因为没有复发。我们的分析还强调了详细的组织学评估对于在内镜切除中确认根治的重要性，尤其是在较大的 EGC 情况下。
