结直肠上皮内瘤变及早期结直肠癌内镜治疗手术前后病理结果对比分析

目的探讨结直肠上皮内瘤变及早期结直肠癌内镜切除术前后病理的差异,为提高结肠镜诊断早期结直肠癌的敏感度和特异度提供参考。方法根据纳入与排除标准,确定活检及手术均由我院完成的129例病例作为研究样本。回顾性分析确诊为结直肠高级别上皮内瘤变或早期结直肠癌患者内镜下黏膜切除术(endoscopic mucosal resection,EMR)/内镜黏膜下剥离术(endoscopic submueosal dissection,ESD)标本资料及其术前病理活检资料129例,比较术前、术后病理结果差异,并分析内镜治疗手术前后病理差异的相关危险因素。比较不同部位(升结肠、横结肠、降结肠、乙状结肠、直肠)及病灶形态(带蒂、广基、侧向发育型)、病灶最长直径、性别、年龄患者的病理活检和EMR/ESD标本病理结果准确性的差异。结果结肠镜术前活检病理与内镜EMR/ESD治疗术后病理诊断符合率为17.1%(22/129),内镜治疗术后病理诊断升级者为103例(79.8%),病理诊断降级者为4例(3.1%)。各个部位轻判率分别为82.4%、80.0%、85.7%、80.9%、76.7%,差异无统计学意义(P>0.05)。单因素Logistic回归分析结果表明:带蒂息肉患者术前活检轻判的现象更明显,差异有统计学意义(P<0.05),而对于病灶位置、最长直径、性别、年龄差异的患者术前活检轻判率差异无统计学意义(P>0.05)。结论术前活检病理诊断与EMR/ESD术后病理诊断的符合率较低,但其为内镜随访和手术治疗方式的选择提供一定依据;带蒂息肉患者更容易发生术前活检轻判,所以对带蒂息肉患者活检诊断上皮内瘤变,可根据情况,必要时结合窄带成像放大内镜技术,来选择EMR/ESD手术,并结合术后标本病理诊断情况来决定是否需要后续治疗及内镜随访时间。

Comparative analysis on pathological results of preoperative & postoperative colorectal intraepithelial neoplasia and early colorectal cancer endoscopic therapies

Objective To provide reference for the improved pathological diagnosis of lesions of the tissues by exploring pathological differences of preoperative and postoperative endoscopic polypectomy for colorectal intraepithelial neoplasia and early colorectal cancer. Methods One hundred and twenty nine patients receiving both biopsies and surgeries based on the inclusion and exclusion criteria were selected as study samples, the specimen data and preoperative pathology biopsy data of 129 patients diagnosed with high-grade colorectal intraepithelial neoplasia or early colorectal cancer patients under endoscopic mucosal resection (EMR)/ endoscopic submucosal dissection (ESD) were retrospectively analyzed, differences in preoperative and postoperative pathological results were compared, and the risk factors associated with pathological differences in preoperative and postoperative endoscopic therapies were analyzed. Differences in the accuracy of pathological biopsies and EMR/ESD samples of patients with different parts (ascending colon, transverse colon, descending colon, sigmoid colon, rectum), lesion morphology (pedicled, sessile and lateral developmental morphology), maximum diameter of lesions, gender and age were observed. Results The diagnostic accordance rate of the postoperative pathological diagnosis of preoperative colonoscopy biopsies and endoscopic EMR/ESD therapies was 17.1% (22/129), the number of postoperative pathological ascending and descending lesions of endoscopic therapies amounted to 103 cases (79.8%) and 4 cases (3.1%), respectively, the mild-severity judgment rate of sites was 82.4%, 80.0%, 85.7%, 80.9% and 76.7%, respectively, and differences weren’t statistically significant (P>0.05). The results of single-factor Logistic regression analysis showed that the phenomenon of mild-severity judgments on preoperative biopsies was more obvious in patients with pedunculated polyps, and difference was statistically significant (P<0.05), while difference in mild-severity judgment rate for preoperative biopsies was not statistically significant for the lesion site, maximum diameter, sex, and age (P>0.05). Conclusion Both the preoperative pathological biopsy diagnosis and postoperative EMR/ESD pathological diagnosis with low compliance rate provide certain basis for selection on endoscopic follow-up and surgical treatment. Patients with pedunculated polyps are vulnerable to mild severity judgment for preoperative biopsies. Therefore, patients with pedunculated polyps are subject to intraepithelial neoplasia diagnose via biopsies, EMR/ESD surgery is supported to be selected based on the conditions in combination with narrow band imaging and magnifying endoscopy technique, and necessities for follow-up treatment and endoscopic follow-up time are supported to be determined by combining the pathological diagnosis on postoperative specimens.