Spectrum of final pathological diagnosis of gastric adenoma after endoscopic resection
Spectrum of final pathological diagnosis of gastric adenoma after endoscopic resection
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DOI：
10.3748/wjg.v17.i47.5177
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发表时间：
2011-12-21
影响因子：
4.3
通讯作者：
Jeong, Hyun Yong
中科院分区：
文献类型：
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作者：
Nam, Kwan Woo;Song, Kyu Sang;Jeong, Hyun Yong
目的：探讨转移性腺瘤患者内窥镜治疗前后有多少差异及其原因。方法：我们回顾了2006年7月至2009年6月在中南国立大学医院接受内窥镜黏膜切除术(EMR)或内窥镜黏膜下剥离术(ESD)治疗的554例患者的资料。治疗前复查胃镜142例，活检108例。3名内窥镜医生(1名、2名和3名)进行了所有EMR或ESD检查，3名病理学家(1名、2名和3名)诊断了大部分病例。结果：554例转移性腺瘤患者中，腺癌72例，占13.0%。异型增生级别高(55.0%)，活检例数>3例(22.7%)，大小不小于2.0 cm(23.2%)，形态欠佳(35.8%)或Yamada型。(100%)，颜色为红色(30.9%)或混合或不确定(25.0%)，其恶性程度明显高于其他类型(P<；0.05)。经胃镜检查确诊为腺癌的18例胃腺瘤均由胃镜医师1完成手术，其恶性程度不同(P=0.027)。结论：高度不典型增生是判断胃腺瘤恶性程度的最重要因素。这种差异主要可能是因为不适当地选择了不存在癌细胞的活检部位，但在某种程度上也取决于病理学家。(C)2011年白石登。版权所有。
AIM: To investigate how many discrepancies occur in patients before and after endoscopic treatment of referred adenoma and the reason for these results.METHODS: We retrospectively reviewed data from 554 cases of 534 patients who were referred from primary care centres for adenoma treatment and treated for endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) at Chungnam National University Hospital, from July 2006 to June 2009. Re-endoscopy was examined in 142 cases and biopsy was performed in 108 cases prior to treatment. Three endoscopists (1, 2 and 3) performed all EMRs or ESDs and three pathologists (1, 2 and 3) diagnosed most of the cases. Transfer notes, medical records and endoscopic pictures of these cases were retrospectively reviewed and analyzed.RESULTS: Adenocarcinoma was 72 (13.0%) cases in total 554 cases after endoscopic treatment of referred adenoma. When the grade of dysplasia was high (55.0%), biopsy number was more than three (22.7%), size was no smaller than 2.0 cm (23.2%), morphologic type was depressed (35.8%) or yamada type. (100%), and color was red (30.9%) or mixed-or-undetermined (25.0%), it had much more malignancy rate than the others (P < 0.05). All 18 cases diagnosed as adenocarcinoma in the re-endoscopic forceps biopsy were performed by endoscopist 1. There were different malignancy rates according to the pathologist (P = 0.027).CONCLUSION: High grade dysplasia is the most important factor for predicting malignancy as a final pathologic diagnosis before treating the referred gastric adenoma. This discrepancy can occur mainly through inappropriately selecting a biopsy site where cancer cells do not exist, but it also depends on the pathologist to some extent. (C) 2011 Baishideng. All rights reserved.