AN ENDOSCOPIC BIOPSY PROTOCOL CAN DIFFERENTIATE HIGH-GRADE DYSPLASIA FROM EARLY ADENOCARCINOMA IN BARRETTS-ESOPHAGUS
AN ENDOSCOPIC BIOPSY PROTOCOL CAN DIFFERENTIATE HIGH-GRADE DYSPLASIA FROM EARLY ADENOCARCINOMA IN BARRETTS-ESOPHAGUS
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DOI：
10.1016/0016-5085(93)90008-z
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发表时间：
1993-07-01
期刊：
影响因子：
29.4
通讯作者：
REID, BJ
中科院分区：
文献类型：
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作者：
LEVINE, DS;HAGGITT, RC;REID, BJ
背景：由于担心内窥镜活检诊断的准确性，在Barrett‘s食道高度不典型增生患者中，检查与切除之间存在争议。本研究的目的是探讨无明显食道癌的Barrett‘s上皮瘤样变患者的胃镜活检方案的准确性。方法：对28例Barrett’s食管腺上皮高度异型增生或早期腺癌患者的术前、术后诊断进行分析，并与22例在前瞻性胃镜监视下维持的高度异型增生患者进行比较。所有50名患者都没有肉眼看起来像是食道癌的病变。结果：总体而言，%的患者有轻微但明显的内窥镜异常，这些异常是作为活检目标的。单纯高度不典型增生(7例)与早期腺癌(19例)相鉴别。2例术前诊断为粘膜内腺癌的患者手术切除标本均为高度不典型增生。结论：该方法能准确发现和鉴别Barrett‘s食管腺癌与高度不典型增生。通过这样的方案发现Barrett‘s食道中仅有高度不典型增生的患者不一定需要手术切除以排除未诊断的腺癌；选择手术应该基于其他临床考虑。
Background:Surveying vs. performing resection in patients with high-grade dysplasia in Barrett's esophagus is debated because of concern about the accuracy of endoscopic biopsy diagnosis. The aim of this study was to investigate the accuracy of an endoscopic biopsy protocol in patients with neoplastic abnormalities in Barrett's epithelium without obvious esophageal cancer.Methods:Preoperative and postoperative diagnoses in 28 patients who underwent surgery for high-grade dysplasia or early adenocarcinoma in Barrett's esophagus and compared them with 22 other patients with high-grade dysplasia who were maintained under prospective endoscopic surveillance. All 50 patients lacked gross lesions to suggest esophageal cancer. The endoscopic protocol involved rigorous, systematic acquisition of multiple, large biopsy samples.Results:Overall, 64% of patients had minimal but distinct endoscopic abnormalities that were targeted for biopsies. High-grade dysplasia alone (7 patients) was differentiated from early adenocarcinoma (19 patients). Two patients with preoperative diagnoses of intramucosal adenocarcinoma had high-grade dysplasia in their resection specimens.Conclusions:This endoscopic protocol accurately detects and differentiates high-grade dysplasia from early adenocarcinoma in Barrett's esophagus. Patients with high-grade dysplasia alone in Barrett's esophagus detected by such a protocol do not necessarily require surgical resection to rule out an undiagnosed adenocarcinoma; electing for surgery should be based on other clinical considerations.