实体显微镜下靶向取材对提高早期大肠癌检出率的研究

目的 建立一套适合内镜下黏膜剥离切除标本的临床病理取材方法,以提高早期大肠癌的检出率。方法 采用2005年8至12月南方医院常规结肠镜检查行内镜下黏膜剥离切除的大肠肿瘤性病变标本,对病变超过10mm以上可疑癌变的病例,采用黏膜染色,结合实体显微镜进行观察,根据腺管开口类型判断可疑癌变部位进行靶向取材病理检查,并与常规随机取材的标本进行对照,观察对大肠癌变检出率的影响,同时,将该期大肠早期癌检出情况与2004年随机取材的检出率进行对照。结果 采用黏膜染色结合实体显微镜进行靶向取材,在40例可疑癌变病例中,确诊早期癌变（包括重度不典型增生）16例,这16例标本随机取材送检后,除1例病理诊断为重度不典型增生外,其余15例均为轻度或中度不典型增生。2004年同期进行非靶向取材,在54例可疑癌变的大肠肿瘤中仅检出4例早期癌变（包括重度不典型增生）,检出率为7．4％。结论 内镜下黏膜剥离切除标本采用黏膜染色实体显微镜进行靶向定位活检,可提高大肠早期癌变的检出率。

Sample targeting under stereomicroscopy can raise the detection rate of early colorectal cancer

Objective To establish a set of pathological diagnosis method to raise the detection rate of early colorectal cancer. Methods All patients with colorectal tumor underwent ordinary electron enteroscopy in 2005. The lesions larger than 10 mm underwent indigo carmine staining and magnifying electron enteroscopy to observe the pit pattern. Endoscopic mucosal resection (EMR) or endoscopic piecemeal resection (EPMR) was performed on the suspected cases of cancer, such as laterally spreading tumor (LST). The resected specimens were stained with cresyl violet and observed by stereomicroscopy to determine the pit patterns. The parts showing the pit patterns associated with early colorectal cancer were targeted and biopsy specimens collected here to undergo pathohistological examination. Routine pathological examination was conducted on the other parts of the same specimen as control. The results of these specimens were compared with those of the specimens collected by ordinary methods from the patients with colorectal tumor in 2004. Results In 2005 40 patients with colorectal tumor were suspected as with cancer and underwent EMR or EPMR of which 16 were confirmed to be with early stage colorectal cancer, including severe dysplasia by sampling targeting (40%). And the routine pathohistological examination of the randomly collected parts from these same specimens showed 15 cases of mild or moderate dysplasia and only one case of severe dysplasia, with a detection rate of 2.5%, significantly lower than that of the result of sample targeting under stereomicroscopy (P<0.01). In 2004, out of the 54 patients suspected to be with colorectal cancer only 4 cases of early cancer, including severe dysplasia were detected with a detection rate of 7.4%, significantly than that of the year 2005 (P<0.01). Conclusion Sample targeting and localized biopsy under stereomicroscopy raises the detection rate of early colorectal cancer.