结直肠上皮内瘤变和癌的新概念与临床应用

目的介绍WHO（2000年）对结直肠上皮内瘤变和癌的活检诊断标准,旨在避免过度或过低诊断。方法根据WHO（2000年）对结直肠上皮内瘤变和癌的活检诊断标准,对2001年1月至2005年10月间,56例手术标本诊断为癌和上皮内瘤变的病理切片及同一患者术前活检切片进行对照研究。结果56例患者中术前活检诊断原位癌、黏膜内癌、腺瘤癌变16例,根据新标准有14例应更正为高级别上皮内瘤变。结论根据WHO（2000年）对结直肠上皮内瘤变和癌的活检诊断标准,可避免过度诊断;但对活检见不到黏膜肌的病例须紧密结合临床各项检查进行综合诊断,以免造成过低诊断导致贻误治疗。

New concept and clinical application of colorectal intraepithelial neoplasia and carcinoma

Objective To introduce the WHO 2000 diagnostic criteria of biopsy of colorectal intraepithelial neoplasia and carcinoma and to enhance diagnostic accuracy and avoid overdiagnosis and underdiagnosis. Method The postoperative pathological examination and preoperative biopsy in 56 patients diagnosed as colorectal intraepithelial neoplasia and carcinoma before operation from January 2001 to October 2005 were compared retrospectively. Results Among the 56 cases, 16 patients were diagnosed by preoperative biopsy as carcinoma in situ, intramucosal carcinoma and adenocarcinoma, but according to the new standard, of them 14 cases should be revised to be higher grade colorectal intraepithelial neoplasia. Conclusions Strictly adhere to the new WHO criteria, colorectal intraepithelial neoplasia and carcinoma can be diagnosed properly, but for the cases that submucosal muscular layer would not presented in biopsy, the diagnosis should be made by combining clinical tindings and various examination results so as to avoid underdiagnosis and delay of treatment.