Vervloet Gil, De Backer Antoine, Heyman Stijn, Leyman Paul, Van Cauwenberge Sebastiaan, Vanderlinden Kim, Vercauteren Charlotte, Vervloessem Dirk, Miserez Marc
Universitair Ziekenhuis Leuven, Katholieke Universiteit Leuven, 3000 Leuven, Belgium.
Universitair Ziekenhuis Brussel, KidZ Health Castle, Saffier Network, 1000 Brussels, Belgium.
Children (Basel). 2023 Aug 31;10(9):1488. doi: 10.3390/children10091488.
The heterogeneity of rectal biopsy techniques has encouraged us to search for a surgical and pathological standardisation of this diagnostic technique to exclude Hirschsprung's disease. The different amounts of information on the anatomopathology report prompted us to compile a template for the anatomopathology report for diagnostic rectal biopsies for surgical colleagues and pathologists working on Hirschsprung's disease.
We gathered the anonymous biopsy information and its pathology information from five hospitals for all patients in which rectal biopsies were taken to diagnose Hirschsprung's disease over two years (2020-2021).
Of the 82 biopsies, 20 suction (24.4%), 31 punch (37.8%) and 31 open biopsies (37.8%) were taken. Of all biopsies, 69 were conclusive (84.2%), 13 were not (15.8%). In the suction biopsy group, 60% were conclusive and 40% were not; for punch biopsy, the values were 87% and 13%, respectively and for open biopsy, 97% and 3%. Inconclusive results were due to insufficient submucosa in 6/8 suction biopsies, 4/4 punch biopsies and 0/1 open biopsies. An insufficient amount of submucosa was the reason for an inconclusive result in 6/20 cases (30%) after suction biopsy, 4/31 (12.9%) cases after punch biopsy and 0 cases (0%) after open biopsy. We had one case with major postoperative bleeding post suction biopsy; there were no further adverse effects after biopsy.
Diagnostic rectal biopsies in children are safe. Non-surgical biopsies are more likely to give inconclusive results due to smaller amounts of submucosa present in the specimen. Open biopsies are especially useful when previous non-surgical biopsies are inconclusive. An experienced pathologist is a key factor for the result. The anatomopathology report should specify the different layers present in the specimen, the presence of ganglion cells and hypertrophic nerve fibres, their description and a conclusion.
直肠活检技术的异质性促使我们寻求这种诊断技术的手术和病理标准化，以排除先天性巨结肠病。解剖病理学报告中信息量的差异促使我们为从事先天性巨结肠病研究的外科同事和病理学家编制一份诊断性直肠活检的解剖病理学报告模板。
我们收集了五家医院在两年（2020 - 2021年）内所有因诊断先天性巨结肠病而进行直肠活检的患者的匿名活检信息及其病理信息。
在82次活检中，采用了20次抽吸活检（24.4%）、31次穿刺活检（37.8%）和31次开放活检（37.8%）。在所有活检中，69次结果明确（84.2%），13次不明确（15.8%）。在抽吸活检组中，60%结果明确，40%不明确；穿刺活检的相应比例分别为87%和13%，开放活检为97%和3%。不明确结果的原因是6/8次抽吸活检、4/4次穿刺活检和0/1次开放活检的黏膜下层不足。黏膜下层数量不足是6/20例（30%）抽吸活检、4/31例（12.9%）穿刺活检和0例（0%）开放活检结果不明确的原因。我们有1例在抽吸活检后出现严重术后出血；活检后无其他不良反应。
儿童诊断性直肠活检是安全的。由于标本中黏膜下层较少，非手术活检更有可能得出不明确的结果。当先前非手术活检结果不明确时，开放活检特别有用。经验丰富的病理学家是获得结果的关键因素。解剖病理学报告应详细说明标本中存在的不同层次、神经节细胞和肥厚神经纤维的存在情况、它们的描述以及结论。
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