Risk factors in malignant transformation of gastric epithelial neoplasia categorized by the revised Vienna classification: endoscopic, pathological, and immunophenotypic features
Risk factors in malignant transformation of gastric epithelial neoplasia categorized by the revised Vienna classification: endoscopic, pathological, and immunophenotypic features
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DOI：
10.1007/s10120-010-0550-7
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发表时间：
2010-06-01
期刊：
影响因子：
7.4
通讯作者：
Chung, In-Sik
中科院分区：
文献类型：
--
作者：
Jung, Sung Hoon;Chung, Woo Chul;Chung, In-Sik
根据修订后的维也纳分类，胃上皮肿瘤第3类（低度不典型增生）病变不需要手术切除，而第4类病变（高度不典型增生和粘膜内癌）则必须切除。然而，大约15%-30%的低度腺瘤/不典型增生进展为高度病变或腺癌，并且很难确定哪些病变将进展为真正的恶性肿瘤。本研究的目的是根据修订后的维也纳分类评估3类和4类病变之间的内镜、病理和免疫表型差异。所有组织样本均通过内镜粘膜切除术切除。通过内窥镜检查结果评估了 52 个 3 类组织样本和 54 个 4 类样本；通过周围粘膜的病理学检查；单因素分析显示，病灶大小、颜色变化、溃疡、周围黏膜胃炎评分、MUC6阳性表达与4类病灶相关。多因素分析显示，病灶大小、溃疡情况、MUC6阳性表达与4类病灶密切相关。病灶直径超过17 mm或伴有溃疡的病灶有恶变的可能。 MUC6 的阳性免疫反应性似乎是胃上皮肿瘤恶性转化的补充标志物。
According to the revised Vienna classification, the surgical removal of gastric epithelial neoplasia category 3 (low-grade dysplasia) lesions is not necessary, whereas the removal of category 4 lesions (high-grade dysplasia and intramucosal cancer) is obligatory. However, approximately 15%-30% of low-grade adenomas/dysplasia progress to highgrade lesions or adenocarcinoma, and it is difficult to determine which lesions will advance to true malignancy. The aim of this study was to evaluate the endoscopic, pathological, and immunophenotypic differences between category 3 and 4 lesions according to the revised Vienna classification.All tissue samples were excised by endoscopic mucosal resection. Fifty-two category 3 tissue samples and 54 category 4 samples were evaluated by endoscopic findings; by pathology examination of the surrounding mucosa; and by CD10, MUC2, MUC5AC, MUC6, and RUNX3 immunohistochemical staining.Univariate analysis showed that the size of the lesion, color change, ulceration, gastritis score of the surrounding mucosa, and positive expression of MUC6 were associated with category 4 lesions. Multivariate analysis showed that the size of the lesion, ulceration, and positive expression of MUC6 were strongly associated with category 4 lesions.Lesions more than 17 mm in diameter or lesions that are associated with ulceration have the potential for malignant transformation. Positive immunoreactivity for MUC6 appears to be a complementary marker for malignant transformation of gastric epithelial neoplasia.