Department of Gastrointestinal Surgery, Zibo Municipal Hospital, Zibo, 255400, Shandong, China.
Department of Pathology, Zibo Municipal Hospital, 139 Huan Gong Road, Linzi District, Zibo, 255400, Shandong, China.
BMC Gastroenterol. 2024 Aug 8;24(1):253. doi: 10.1186/s12876-024-03342-4.
The pathological results obtained from endoscopic forceps biopsy (EFB) do not always align with the findings of postoperative endoscopic submucosal dissection (ESD). Furthermore, as ESD becomes more widespread, the number of noncurative endoscopic cases increases; thus, an accurate preoperative diagnosis and an appropriate treatment method are crucial. The purpose of this study was to explore the risk factors for postoperative pathological upgrading and noncurative resection and to gather experience in clinical and pathological diagnosis.
From March 2016 to November 2023, 292 ESD specimens were collected from 262 patients with gastric mucosal lesions. Clinicopathological information, the coincidence rate of pathological diagnosis between EFB and ESD specimens, and risk factors related to noncurative resection were analyzed retrospectively.
The overall upgraded pathological diagnosis rate between EFB and ESD was 26.4%. The independent predictors for the upgraded group included proximal stomach lesions, lesion size > 2 cm, surface ulceration, and surface nodules. Twenty of the 235 early gastric cancer (EGC) patients underwent noncurative ESD resection. Multivariate analysis showed that undifferentiated carcinoma and tumor infiltration into the submucosa were significantly associated with noncurative resection.
Biopsy cannot fully represent the lesions of gastric intraepithelial neoplasia (GIN). When a suspected epithelial dysplasia is suspected, a careful endoscopic examination should be conducted to evaluate the lesion site, size, and surface characteristics to ensure an accurate diagnosis. Noncurative endoscopic resection is associated with undifferentiated carcinoma and submucosal infiltration. Clinicians must be familiar with these predictive factors for noncurative resection and select the appropriate treatment for their patients.
内镜下黏膜剥离术（ESD）的术后病理结果并不总是与内镜下钳夹活检（EFB）的病理结果一致。此外，随着 ESD 的广泛应用，非治愈性内镜病例的数量增加；因此，准确的术前诊断和适当的治疗方法至关重要。本研究旨在探讨术后病理升级和非治愈性切除的危险因素，并积累临床和病理诊断经验。
2016 年 3 月至 2023 年 11 月，对 262 例胃黏膜病变患者的 292 例 ESD 标本进行了回顾性分析。分析了临床病理资料、EFB 和 ESD 标本病理诊断的符合率以及与非治愈性切除相关的危险因素。
EFB 和 ESD 之间总体升级病理诊断率为 26.4%。独立预测因素包括胃上部病变、病变大小>2cm、表面溃疡和表面结节。235 例早期胃癌（EGC）患者中有 20 例进行了非治愈性 ESD 切除。多因素分析显示，未分化癌和肿瘤浸润黏膜下层与非治愈性切除显著相关。
活检不能完全代表胃上皮内瘤变（GIN）的病变。当怀疑上皮异型增生时，应仔细进行内镜检查，评估病变部位、大小和表面特征，以确保准确诊断。非治愈性内镜切除与未分化癌和黏膜下浸润有关。临床医生必须熟悉这些非治愈性切除的预测因素，并为其患者选择合适的治疗方法。
