结直肠息肉样病变内镜活检和内镜切除术后病理差异分析*

Analysis of the pathological discrepancy between endoscopic forceps biopsy and endoscopic resection for colorectal polypoid lesion*

摘要:

摘要：目的??探讨结直肠息肉样病变的内镜活检病理与内镜切除术后病理的差异，分析其相关危险因素以及内镜活检的局限性。方法 回顾性分析结直肠息肉样病变52例，内镜活检病理包括增生性息肉、炎性息肉以及腺瘤伴低级别上皮内瘤变（LGIN）或高级别上皮内瘤变（HGIN）。所有患者根据内镜下分型及大小选择不同的内镜下切除方式：圈套器高频电切除术、内镜下黏膜切除术（EMR）以及内镜黏膜下剥离术（ESD）。统计患者的临床资料、镜下特点、活检病理及内镜切除术后的病理差异，分析病理结果发生显著差异的危险因素。结果 52例患者中，24例的活检病理与内镜切除病理存在差异，总体差异率为46.2%。其中增生性息肉、炎性息肉、LGIN以及HGIN活检与内镜切除病理的差异率分别为20.0%、42.9%、44.4%及54.5%。直径大于2.0?cm和病变表面充血是影响病理学差异的关键因素（P?<0.05）。结论 内镜活检对于结直肠息肉样病变性质的判断有一定的局限性，应警惕其对结直肠癌前病变及癌变的延迟诊治以及漏诊。

Abstract:

Abstract: Objective?To investigate the pathological discrepancy between endoscopic forceps biopsy (EFB) and endoscopic resection (ER) specimens for colorectal polypoid lesion, and analyze risk factors for the discrepancy and insufficiency of endoscopic forceps biopsy.?Methods?A retrospective analysis was performed on the data of 52 cases of colorectal polypoid lesion, which EFB pathology including hyperplastic polyp, inflammatory polyp, adenoma with low-grade dysplasia (LGD), and adenoma with high-grade dysplasia (HGD). Different endoscopic resections including polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection, were chosen to remove these colorectal polypoid lesions based on the endoscopic classification and size of lesions. Clinical data, endoscopic characteristics, the pathological discrepancy between EFB and ER specimens were collected, and the risk factors for significant pathological discrepancy were analyzed.?Results?Among the 52 cases, there were 24 cases which EFB pathology were discrepant form ER specimen pathology, the overall pathological discrepancy rate between EFB and ER specimens was 46.2%. The pathological discrepancy rate of hyperplastic polyp, inflammatory polyp, adenoma with LGD, and adenoma with HGD diagnosed by EFB from ER specimen is 20.0%, 42.9%, 44.4%, and 54.5%, respectively. The size (?﹥?2.0 cm in diameter) and the congestive surface were risk factors associated with the pathological discrepancy between EFB and ER specimens (P?﹤?0.05).?Conclusion?EFB is insufficient for a definite pathological diagnosis of colorectal polypoid lesion. We should be careful of delayed and missed diagnosis for colorectal precancerous lesion and cancer in EFB.