胃癌患者术前胃镜活检病理与外科术后病理异同的研究

目的比较胃癌患者术前胃镜活检病理与外科术后病理的异同。方法收集北京大学第三医院2005—2009年普外科确诊为胃癌并行胃癌根治术,且术前于消化科行胃镜活检的患者共145例,分析其临床病理信息,统计手术前后病理类型、分化程度符合率。结果术前胃镜对胃癌的诊断率达100%,胃镜病理对胃癌病理类型的判断64例与术后病理一致(44.1%),81例不一致(55.9%),术前胃镜与术后病理对胃癌病理类型的判断不一致(Kappa=0.242,P=0.000);对于胃癌分化程度的判断105例与术后病理一致(72.4%),40例不一致(27.6%),胃癌术前胃镜与术后病理对分化程度的判断不一致(Kappa=0.361,P=0.000)。结论胃镜活检对于术前诊断胃癌发挥了重要作用,但对胃癌的全面评估,仍需依据外科术后病理结果。

Comparison of Pathological Features between Preoperative Gastroscopic Biopsy and Postoperative Pathology for Gastric Cancer

Objective To compare the differences of pathological features between the preoperative gastroscopic biopsy and postoperative pathology for gastric cancer.Methods Totally 145 patients who were diagnosed as gastric cancer underwent both preoperative endoscopic biopsy and radical operation in Peking University Third Hospital during 2005—2009.The coincidence rates of pathological type and differentiation degree between the preoperative and postoperative radical gastrectomy were analyzed.Results Preoperative gastroscopy showed that 100% of the cases were gastric cancer,whereas the postoperative pathology confirmed the same pathological types in 64 patients(44.1%) but not in 81 patients(55.9%)(Kappa=0.242,P=0.000).Meanwhile,the preoperative gastroscopy and postoperative pathology showed the same differentiation degree in 105 patients(72.4%) but not in 40 patients(27.6%)(Kappa=0.361,P=0.000).Conclusion Preoperative gastroscopic biopsy plays an important role in the early diagnosis of gastric cancer,while postoperative pathology is essential for confirmative assessment.