How Commonly Is the Diagnosis of Gastric Low Grade Dysplasia Upgraded following Endoscopic Resection? A Meta-Analysis.
How Commonly Is the Diagnosis of Gastric Low Grade Dysplasia Upgraded following Endoscopic Resection? A Meta-Analysis.
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内镜切除术后胃低度不典型增生的诊断升级的频率如何？
DOI：
10.1371/journal.pone.0132699
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Wang L
中科院分区：
文献类型：
--
作者：
Zhao G;Xue M;Hu Y;Lai S;Chen S;Wang L
胃发育不良是一种众所周知的癌前病变。虽然胃低度不典型增生（LGD）的诊断通常是通过内镜钳活检（EFB）做出的，但许多经EFB证实的胃LGD通过内镜切除（ER）程序进一步诊断测试升级为胃高度不典型增生（HGD）甚至癌（CA），其准确性值得怀疑。我们的目的是评估 ER 对 EFB 证实的胃 LGD 病变的升级诊断率 (UDR) 和危险因素。两名研究人员从数据库中独立检索了报告 EFB 证实的胃 LGD 病变中 ER 的 UDR 的研究，并分析了总体 UDR、HGD-UDR 和 CA-UDR。在 EFB 证实的胃 LGD 病变中，ER 汇总的 UDR 为 25.0%（95% CI，20.2%-29.8%），由 HGD-UDR 和 CA-UDR 组成，比例分别为 16.7%（95% CI，12.8%-20.6%）和 6.9%（95% CI，4.2%-9.6%）。病灶尺寸大于2 cm、内镜检查表面凹陷、结节是UDR的主要危险因素。总之，四分之一经EFB证实的胃LGD病变将被ER诊断为晚期病变，包括胃HGD（16.7%）和胃CA（6.9%）。内镜下直径大于2cm、表面凹陷或结节状的LGD病灶经ER后更容易升级诊断。
Gastric dysplasia is a well-known precancerous lesion. Though the diagnosis of gastric low grade dysplasia (LGD) is generally made from endoscopic forceps biopsy (EFB), the accuracy is doubtful after numerous EFB-proven gastric LGD were upgraded to gastric high grade dysplasia (HGD) or even carcinoma (CA) by further diagnostic test with the procedure of endoscopic resection (ER). We aimed to evaluate the upgraded diagnosis rate (UDR) and the risk factors by ER in EFB-proven gastric LGD lesions. Two investigators independently searched studies reporting the UDR by ER in EFB-proven gastric LGD lesions from databases and analyzed the overall UDR, HGD-UDR and CA-UDR. The pooled UDR by ER in EFB-proven gastric LGD lesions was 25.0% (95% CI, 20.2%-29.8%), made up of HGD-UDR and CA-UDR by rates of 16.7% (95% CI, 12.8%-20.6%) and 6.9% (95% CI, 4.2%-9.6%) respectively. Lesion size larger than 2 cm, surface with depression and nodularity under endoscopic examinations were the major risk factors associated with UDR. In conclusion, one quarter of EFB-proven gastric LGD lesions will be diagnosed as advanced lesions, including gastric HGD (16.7%) and gastric CA (6.9%) by ER. The diagnosis of those LGD lesions with an endoscopic diameter larger than 2cm, and depressed or nodular surface are more likely to be upgraded after ER.