胃镜活检与内镜下黏膜切除病理诊断比较
收稿日期：2014-12-12；修回日期：2015-01-18通讯作者：王进武，E -mail ：Wangjw855@
王进武，常玲云，安梅芳，赵国强，郝长青，王伟
（林州市肿瘤医院，河南林州456550）
摘要：［目的］探讨胃镜活检在食管早期癌及其癌前病变诊断中的价值以及影响其准确性的因素。［方法］对在河南省林州市肿瘤医院实施内镜下黏膜切除(EMD)的618例食管早期癌及癌前病变的诊断结果进行回顾性分析。比较分析内镜活检病理结果与EMD 术后病理诊断的一致性。［结果］术前活检病理和EMD 术后病理诊断的总体一致率为58.09%（359/618），其中轻度、中度、重度不典型增生完全一致率分别为50.00%（6/12）、49.35%（38/77）、59.83%（210/351），原位癌和早期癌诊断的一致率分别为50.42%（60/119）和77.19%（44/57）。2例活检为炎症的病例，术后1例诊断为重度不典型增生。术后病理诊断较活检病理病变程度减轻的有64例（10.36%，64/618），加重的有195例（31.55%，195/618）。影响活检准确性的因素主要有内镜咬检因素、病理诊断差异和病情转化。［结论］活检病理诊断与EMD 术后病理诊断结果存在较大差异，EMD 术后病理是活检病理的补充，为临床规范治疗提供可靠依据。关键词：食管癌前病变；活检病理；早癌；内镜下黏膜切除中图分类号：R735.1文献标识码：A 文章编号：1004-0242（2015）09-0797-04doi ：10.11735/j.issn.1004-0242.2015.09.A018
An Analysis of Pathologic Diagnosis between Endoscopic Biopsy and Endoscopic Mucosal Dissection
WANG Jin -wu ，CHANG Ling -yun ，AN Mei -fang ，et al.
（Tumor Hospital of Linzhou ，Linzhou 456550，China ）
Abstract ：［Purpose ］To investigate the value of endoscopic biopsy pathology in diagnosis of early carcinoma and precancerous lesions of the esophagus ，and to analyze the related factors affecting the accuracy.［Methods ］A retrospective analysis on 618cases with early esophageal cancers or the precursor lesions treated by EMD (endoscopic mucosal dissection)in the tumor Hospital of Henan Linzhou was performed.and the discrepancy of pathological diagnosis between endoscopic biopsies and specimens after EMD was analyzed.［Results ］The full consistency rate of pathological diag -nosis between preoperative biopsies and postoperative specimens was 58.09%(359/618).Among this ，the full consistency rate of mild ，moderate and severe atypical hyperplasia identical rate was 50.00%(6/12)，49.35%(38/77)and 59.83%(210/351)，while it of carcinoma in situ and early cancer was 50.42%(60/119)and 77.19%(44/57).Among the 2cases in inflammation of preoperative biop -sies ，there was 1case was confirmed for severe atypical hyperplasia after EMD.In addition ，com -pared with the preoperative biopsy ，64cases (10.36%，64/618)postoperative pathological diagnosis alleviated ，while 195cases (31.55%，195/618)became more severity.The factors influencing the accuracy of the endoscopic biopsy pathology were endoscopic check factors ，the pathological diag -nosis of differences and the patients ’disease change.［Conclusion ］There is a certain gap between preoperative biopsy and postoperative pathology.EMD of postoperative pathology is well supported for biopsy pathology ，both of whom provide a reliable basis for clinical standardized treatment.
Key words ：esophageal precursor lesion ；biopsy pathology ；early cancer ；endoscopic mucosal dissection
内镜检查是消化道肿瘤检查的重要手段，活检病理诊断是判断肿瘤性质的常规方法，如何提高内
镜活检病理的诊断结果与临床实际病变情况一致性是临床和医技医师共同关注的问题。近几年发展较快的内镜下消化道黏膜微创技术取得较好的治疗效果，同时也为比较评价术前活检病理的准确性提供
797本文由中国卫生产业杂志提供
