摘要
目的:探讨世界卫生组织(WHO)结直肠癌诊断标准在术前内镜活组织检查标本病理诊断中的应用价值。方法:根据WHO结直肠癌诊断标准,只有明确的黏膜肌层浸润,才能被诊断为癌。回顾性分析2005年1月—2011年12月经手术切除的52例结直肠癌患者的术前活组织检查病理切片,观察肿瘤浸润黏膜肌层的情况,并与其术后病理检查结果作比较。结果:32例(61.5%)有黏膜肌层浸润,诊断为结直肠癌,15例(28.9%)未见黏膜肌层浸润,诊断为高级别上皮内瘤变,其余5例(9.6%)腺体异型不明显,考虑受活组织检查取材影响,只能诊断为低级别上皮内瘤变。而52例(100%)的术后病理检查全部确诊为浸润性腺癌。结论:WHO结直肠癌诊断标准在术前活组织检查病理诊断中有较高的误诊率,应该引起足够的重视。这一标准尚需进一步完善。实际工作中对结直肠癌的活组织检查诊断,应结合肿瘤的大体类型、细胞形态、腺体结构及内镜检查结果进行综合分析判断,避免将癌诊断为高级别上皮内瘤变而延误治疗,后者只适用于手术切除标本的诊断。
Objective ： To evaluate the use of diagnostic criteria of WHO for colorectal carcinoma in pathological diagnosis by preoperative endoscopic biopsy. Methods： According to the WHO colorectal cancer diagnostic criteria,only if the invasion of muscularis mucosaeis is definite,it can be diagnosed with colorectal carcinoma. The pathological sectiones by preoperative bi- opsies of 52 cases of colorectal carcinoma removed surgically admitted between Jan 2005 to Dec 2011 were analyzed retrospec- tively. To observe the invasion of muscularis mucosae, and the postoperative pahtological examination result was compared with preoperative biopsy examination. Results ：32 cases （61.5 % ） that muscularis mucosae was infiltrated were diagnosed colorectal carcinoma . 1 5 cases （ 2 8.9 % ） that it wasn tt infiltrated were diagnosed high - grade intraepithelial neoplasm. Other5 cases （9.6%） that glands atypia was not obvious,considering it under the influence of the biopsy can only were diagnosed with low - grade intraepithelial neoplasm. With postoperative pathological examination, all of 52 cases （ 100% ） were identified as infil- trative adenocarcinoma. Conclusion ： It should be pay more attention to it that the diagnostic criteria of WHO for colorectal car- cinoma has high misdiagnosis rate in pathological diagnosis by preoperative biopsy. This standard needs to be further improved. To avoid it misdiagnosed as high - grade intraepithelial neoplasm to delay treatment, diagnosis of colorectal carcinoma by pre- operative endoscopic biopsy in practical work, should be combined with tumor gross type, cell morphology, glandular structures and endoscopic results to comprehensive analysis and judgment. High - grade intraepithelial neoplasm is only applicable to the diagnosis of surgical specimens.
出处
《临床医药实践》
2013年第11期810-813,共4页
Proceeding of Clinical Medicine
关键词
结直肠癌
活组织检查
病理诊断
colorectal carcinoma
biopsy
pathological diagnosis
