Zheng Zhuoqun, Ding Jin, Chen Yanping, Hua Hongjun
Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, Zhejiang, P.R. China.
BMC Gastroenterol. 2025 Sep 2;25(1):632. doi: 10.1186/s12876-025-04255-6.
Endoscopic papillectomy (EP) has been used for the treatment of duodenal papillectomy, and the results of preoperative endoscopic biopsy are important for the selection of treatment plans for the patients. However, some lesions cannot be precisely diagnosed based solely on biopsy results. In the study, we attempted to assess the accuracy of histopathological diagnosis of endoscopic forceps biopsy and to avoid over - or under-treatment.
This retrospective observational analysis involved clinical data and endoscopic images of lesions diagnosed as non-cancerous on preoperative biopsy at the Gastroenterology Department of Jinhua Central Hospital from January 2021 to December 2024 and received follow-up treatment. We assessed the histological discrepancies between endoscopic forceps biopsy and specimens, and analyzed their correlation with clinical characteristics.
The study included 58 patients. The discrepancy rate between forceps biopsy and resected specimens was 50% (29/58 ). 28 of the 29 inconsistent biopsies were diagnosed with a higher grade, and the other one was diagnosed as a neuroendocrine tumor. 8 of the 40 biopsies that were diagnosed as indefinite for neoplasia or low-grade intraepithelial neoplasia were upgraded to HGIN or ampullary cancer after resection, which was related to duct (pancreatic duct or bile duct) dilatation (p = 0.003). Moreover, 13 of the 18 biopsies that were diagnosed with HGIN were upgraded to ampullary cancer after resection, which was related to lesion size (p = 0.035), and gender (p = 0.008). According to the postoperative pathological results, the lesions were divided into benign lesions and the malignant(HGIN and ampullary cancer), and histological discrepancy was associated with lesion size (p = 0.008), color (p = 0.000), and duct dilatation ( p = 0.001). Logistic regression analysis revealed that lesion size(OR = 3.566, 95%CI:1.085 ~ 11.723, P = 0.036) was a significant predictor of malignancy in ampullary adenomas.
Histological discrepancies between endoscopic forceps biopsy and resected specimens of ampullary lesions were commonly observed in clinical practice. The presence of symptoms, including red color, lesion size > 1.25 cm and duct dilatation on radiologic imaging suggests the possibility of malignancy in ampullary adenoma.
内镜下乳头切除术（EP）已用于十二指肠乳头切除术的治疗，术前内镜活检结果对于患者治疗方案的选择至关重要。然而，一些病变仅根据活检结果无法准确诊断。在本研究中，我们试图评估内镜钳取活检组织病理学诊断的准确性，并避免过度治疗或治疗不足。
本回顾性观察分析纳入了2021年1月至2024年12月在金华市中心医院消化内科接受术前活检诊断为非癌性病变并接受后续治疗的患者的临床资料和病变内镜图像。我们评估了内镜钳取活检与标本之间的组织学差异，并分析了它们与临床特征的相关性。
该研究纳入了58例患者。钳取活检与切除标本之间的差异率为50%（29/58）。29例不一致的活检中有28例诊断为更高分级，另一例诊断为神经内分泌肿瘤。40例诊断为肿瘤不确定或低级别上皮内瘤变的活检中有8例在切除后升级为高级别上皮内瘤变或壶腹癌，这与导管（胰管或胆管）扩张有关（p = 0.00）。此外，18例诊断为高级别上皮内瘤变的活检中有13例在切除后升级为壶腹癌，这与病变大小（p = 0.035）和性别（p = 0.008）有关。根据术后病理结果，将病变分为良性病变和恶性病变（高级别上皮内瘤变和壶腹癌），组织学差异与病变大小（p = 0.008）、颜色（p = 0.000）和导管扩张（p = 0.001）有关。逻辑回归分析显示，病变大小（OR = 3.566，95%CI：1.085 ~ 11.723，P = 0.036）是壶腹腺瘤恶性程度的重要预测指标。
临床实践中常见内镜钳取活检与壶腹病变切除标本之间的组织学差异。出现红色、病变大小>1.25 cm和影像学检查显示导管扩张等症状提示壶腹腺瘤有恶变的可能。
