作者：杜晓华，牟娜娜，董杏梅，罗碧怡，杨海峰

单位：广州中医药大学第二附属医院（广东省中医院） 病理科， 广东 广州510120

Authors: Du Xiaohua，Mu Nana，Dong Xingmei，Luo Biyi，Yang Haifeng

Unit: Department of Pathology，The Second Affiliated Hospital of Guangzhou University of Chinese Medicine （Guangdong Provincial Hospital of Chinese Medicine），Guangzhou 510120，Guangdong，China

摘要：

目的 比较结直肠上皮内瘤变患者肠镜活检病理与内镜黏膜下剥离术（ESD）标本的病理诊断结果符合率，总结引起差异的相关因素，以期指导活检标本的病理诊断及评价ESD效果。方法 回顾性分析广东省中医院病理科经肠镜活检诊断为肠上皮内瘤变，并行ESD治疗的患者390例，对比分析肠镜活检病理结果与ESD标本病理结果差异。统计两者的诊断符合率，以及肠镜活检病理较ESD标本病理结果诊断不足率和过度诊断率。结果 肠镜活检病理与ESD标本病理诊断符合率为77.4%(302/390)。肠镜活检病理为低级别上皮内瘤变（LGIN）和高级别上皮内瘤变（HGIN）的符合率分别为76.1%(222/292)和81.6%(80/98)，差异无统计学意义（P>0.05）。但诊断不足，即术后病理级别升高占20.8%(81/390)，诊断过度，即术后病理级别降低占1.8%(7/390)。活检病理为LGIN者，ESD标本病理级别升高占24.0%(70/292)，活检病理为HGIN者，ESD标本病理级别降低占11.2%(11/98)。结论 肠镜活检病理与ESD标本病理结果有较高的一致性，但活检病理不能完全反映病变的程度，主要为诊断不足，临床及内镜医生应充分了解引起差异的影响因素。ESD有很好的诊断与治疗价值，能相对客观地评价病理性质，并为进一步治疗提供依据。 

关键词：上皮内瘤变； 活检； 病理； 内镜下黏膜剥离术

Abstract：

Objective To compare the pathological diagnosis differences between preoperative endoscopic biopsy and endoscopic submucosal dissection （ESD） in patients with colorectal intraepithelial neoplasia. Method A total of 390 patients with colorectal intraepithelial neoplasia treated by ESD were enrolled and the differences of pathological findings between preoperative endoscopy and postoperative ESD were compared and analyzed. Result The overall coincidence rate of pathological diagnosis was 77.4%（302/390）in preoperative endoscopy and postoperative ESD. The complete coincidence rates of LGIN and HGIN were 76.1% （222/292）and 81.6% （80/98）respectively，but the difference was not statistically significant. The overall postoperative pathologic degree higher than preoperative endoscopy （underdiagnosis） was accounted for 20.8%（81/390）. whereas lower than preoperative endoscopy （overdiagnosis） was 1.8%（7/390）.The postoperative pathologic degree was 24.0% （70/292） higher than preoperative endoscopy with LGIN，while postoperative pathologic degree was 11.2% （11/98） higher than preoperative endoscopy with HGIN. Conclusion Preoperative pathological biopsy is a good indicator for the diagnosis of gastroesophageal intraepithelial neoplasia. However，there are some differences between preoperative biopsy and postoperative pathology，clinical endoscopists should fully understand the influencing factors of the differences，and fully evaluate the intraepithelial neoplasia. Preoperative biopsy pathology could not completely reflect the degree of pathological changes. Fully evaluation of intraepithelial neoplasia and active ESD treatment could obtain pathological diagnosis accurately.

Key Words:  Intraepithelial neoplasia; Biopsy; Pathology; Endoscopic submucosal dissection