预测结直肠低级别上皮内瘤变内镜活检钳与内镜切除标本组织学升级差异的潜在因素。
Potential Factors Predicting Histopathologically Upgrade Discrepancies between Endoscopic Forceps Biopsy of the Colorectal Low-Grade Intraepithelial Neoplasia and Endoscopic Resection Specimens.
机构信息
Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Department of Respiratory Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.
出版信息
Biomed Res Int. 2022 Jun 6;2022:1915458. doi: 10.1155/2022/1915458. eCollection 2022.
BACKGROUND
It was gradually accepted that endoscopic fragment biopsy (EFB) diagnosis cannot accurately guarantee the absence of higher-grade neoplasms within the lesion of the digestive tract. There are no well-established predictors for histopathologically upgrade discrepancies between EFB diagnosing colorectal low-grade intraepithelial neoplasia (LGIN) and endoscopic resection (ER) specimens.
METHODS
A total of 918 colorectal LGINs was histopathologically diagnosed by EFB, including 162 cases with upgrade discrepancy and 756 concordant cases. We compared clinicopathological data of EFB and ER specimens between these two groups. Multivariate analysis was performed to identify predictors for this upgrade histopathology.
RESULTS
The predominant upgrade discrepancy of LGINs diagnosed by EFB was upgrades to high-grade dysplasia (114/918, 12.4%), followed by upgrades to intramucosal carcinoma (33/918, 3.6%), submucosal adenocarcinoma (10/918, 1.1%), and advanced adenocarcinoma (5/918, 0.5%). NSAID history (OR 4.83; 95% CI, 2.27-10.27; < 0.001), insufficient EFB number (OR 2.99; 95% CI, 1.91-4.68; < 0.001), maximum diameter ≥ 1.0 cm (OR 6.18; 95% CI, 1.32-28.99; = 0.021), lobulated shape (OR 2.68; 95% CI, 1.65-4.36; < 0.001), erythema (OR 2.42; 95% CI, 1.50-3.91; < 0.001), erosion (OR 7.12; 95% CI, 3.91-12.94; < 0.001), surface unevenness (OR 2.31; 95% CI, 1.33-4.01; = 0.003), and distal location of the target adenoma (OR 3.29; 95% CI, 1.68-6.41; < 0.001) were associated with the histologically upgrade discrepancies.
CONCLUSION
NSAID history, insufficient EFB number, adenoma size and location, and abnormal macroscopic patterns are potential predictors for upgrade histopathology of LGINs diagnosed by EFBs. The standardization of EFB number and advanced imaging techniques could minimize the risk of neglecting the potential of this upgrade histopathology.
背景
内镜下分片活检（EFB）诊断不能准确保证消化道病灶内不存在高级别肿瘤，这一观点逐渐被接受。EFB 诊断结直肠低级别上皮内瘤变（LGIN）与内镜切除（ER）标本的组织病理学升级差异无明确的预测因素。
方法
共有 918 例结直肠 LGIN 通过 EFB 进行了组织病理学诊断，其中 162 例有升级差异，756 例符合诊断。我们比较了这两组 EFB 和 ER 标本的临床病理资料。采用多变量分析确定这种升级组织病理学的预测因素。
结果
EFB 诊断 LGIN 的主要升级差异是升级为高级别异型增生（114/918，12.4%），其次是升级为黏膜内癌（33/918，3.6%）、黏膜下腺癌（10/918，1.1%）和高级别腺癌（5/918，0.5%）。使用非甾体抗炎药（NSAID）史（OR 4.83；95%CI，2.27-10.27；<0.001）、EFB 数量不足（OR 2.99；95%CI，1.91-4.68；<0.001）、最大直径≥1.0cm（OR 6.18；95%CI，1.32-28.99；=0.021）、分叶状形态（OR 2.68；95%CI，1.65-4.36；<0.001）、红斑（OR 2.42；95%CI，1.50-3.91；<0.001）、糜烂（OR 7.12；95%CI，3.91-12.94；<0.001）、表面不均匀（OR 2.31；95%CI，1.33-4.01；=0.003）和腺瘤靶位的远端位置（OR 3.29；95%CI，1.68-6.41；<0.001）与组织学升级差异相关。
结论
NSAID 史、EFB 数量不足、腺瘤大小和位置以及异常大体形态是 EFB 诊断 LGIN 组织学升级的潜在预测因素。EFB 数量的标准化和先进的影像学技术可以最大限度地降低忽视这种升级组织病理学的风险。
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