The pathologic measurement of polyp size is preferable to the endoscopic estimate
The pathologic measurement of polyp size is preferable to the endoscopic estimate
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DOI：
10.1016/s0016-5107(97)70002-6
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发表时间：
1997-12-01
影响因子：
7.7
通讯作者：
Margulies, C
中科院分区：
文献类型：
--
作者：
Schoen, RE;Gerber, LD;Margulies, C
背景：没有标准化的技术来测量息肉的大小。内镜下息肉大小的估计是困难的。由病理学家测量息肉大小似乎是一种准确的替代方法，但组织固定可能会改变息肉大小。为了评估确定息肉大小的方法，我们比较了内镜医师的估计和病理学家的测量与测量由一个独立的examinator.Methods：息肉进行了测量，由一个独立的调查之前和之后福尔马林固定。固定前的调查员的测量（“金标准”）进行了比较，内镜医师的估计和病理学家的measurements.Results：10内镜切除61息肉圈套在33例患者：82%是腺瘤和72%是有蒂的。平均尺寸为0.85 ± 0.6 cm（SD）（范围：0.3 - 3.6 cm，26%大于或等于1 cm）。息肉在福尔马林中平均保留239分钟（46至1164分钟）。息肉在福尔马林中既不一致地缩小也不一致地扩大（最大变化+/- 0.2 cm，r = 0.99 [p < 0.001]）。病理学家和研究者福尔马林后测量结果之间的观察者间一致性显示，57个息肉中的55个（97%）在+/- 0.3 cm范围内。内镜医师对56个息肉中的11个（20%）估计不准确（与独立检查者的差异> 0.3 cm）。息肉大小被低估的3例（范围0.5至0.9厘米）和高估的8例（范围0.4至0.8厘米）。在11例病例中的5例（46%）中，这种不准确性改变了1 cm阈值范围内的息肉大小分类。结果不依赖于内镜，组织学，或息肉location.Conclusions：（1）息肉大小是不显着影响福尔马林固定; 2）内镜息肉大小的估计往往是不可靠的;和，如果可能的话，（3）病理学家的息肉大小的测量应在临床试验和临床实践中使用。
Background: There is no standardized technique to measure polyp size. Estimation of polyp size at endoscopy is difficult. Polyp size measurement by pathologists would seem to be an accurate alternative, but tissue fixation may alter polyp size. To evaluate methods of determining polyp size, we compared endoscopists' estimates and pathologists' measurements with measurements made by an independent examiner.Methods: Polyps were measured by an independent investigator before and after formalin fixation. The investigator's measurement before fixation (the "gold standard") was compared with the endoscopists' estimates and the pathologists' measurements.Results: Ten endoscopists removed 61 polyps with a snare in 33 patients: 82% were adenomatous and 72% were pedunculated. Mean size was 0.85 +/- 0.6 cm (SD) (range: 0.3 to 3.6 cm, 26% greater than or equal to 1 cm). Polyps remained in formalin for a mean of 239 minutes (46 to 1164 minutes). Polyps neither consistently shrank nor enlarged in formalin (maximum change +/- 0.2 cm, r = 0.99 [p < 0.001]). Interobserver agreement between pathologists' and the investigator's post-formalin measurements showed that 55 of 57 polyps (97%) were within +/- 0.3 cm. Endoscopists inaccurately estimated 11 of 56 polyps (20%) (> 0.3 cm difference from the independent examiner). Polyp size was underestimated in three instances (range 0.5 to 0.9 cm) and overestimated in eight (range 0.4 to 0.8 cm). In 5 of 11 instances (46%), this inaccuracy altered polyp size classification across the 1 cm threshold. Results were not dependent on endoscopist, histology, or polyp location.Conclusions: (1) Polyp size is not significantly affected by formalin fixation; 2) Endoscopists' estimates of polyp size are often unreliable; and, when possible, (3) Pathologists' measurements of polyp size should be used in clinical trials and in clinical practice.