摘要
目的:比较WHO和日本标准对胃活检病例病理诊断的差异,探讨诊断差异原因,并筛选可用于辅助诊断胃上皮内瘤变的免疫组织化学标志物。材料与方法:收集175例有术前胃活检切片并行内镜下黏膜切除术(EMR)或黏膜剥离术(ESD)的病例,由高年资病理医师分别按照WHO和日本标准复阅病理切片。对比两种标准下活检病理结果与术后诊断的符合率,并对30例术后病例进行HP、P504S、MUC5AC、MUC6、C-MYC、Ki-67、P53的免疫组织化学染色分析。结果:WHO标准与日本标准的诊断结果差异显著(P<0.05)。WHO标准诊断高级别异型增生与术后符合率最高,日本标准诊断无肿瘤符合率最高。P53、P504S和Ki-67在正常胃粘膜至癌变过程中的表达差异显著(P<0.05),而C-MYC、HP、MUC5AC和MUC6的表达无显著差异(P>0.05)。结论:WHO和日本标准在胃活检诊断中存在显著差异,P53、P504S和Ki-67对早期胃癌诊断具有辅助价值。日本标准结合免疫组化染色可提高高级别异型增生和癌的诊断准确性,为胃上皮内瘤变的诊断提供了新方法和新视角,具有重要临床意义。
Objective:To compare the differences in pathological diagnosis of gastric biopsy cases between WHO and Japanese criteria,explore the reasons for diagnostic discrepancies,and identify immunohistochemical markers that can assist in the diagnosis of gastric intraepithelial neoplasia.Materials and Methods:A total of 175 cases with preoperative gastric biopsies followed by endoscopic mucosal resection(EMR)or endoscopic submucosal dissection(ESD)were collected.Reviews of the pathological slides were conducted by senior pathologists according to both WHO and Japanese criteria.The concordance rates between biopsy and postoperative diagnoses under the two criteria were compared.Immunohistochemical staining for HP,P504S,MUC5AC,MUC6,C-MYC,Ki-67,and P53 was performed on 30 postoperative cases.Results:Significant differences were observed in the diagnostic results between WHO and Japanese criteria(P<0.05).The WHO criteria showed the highest concordance rate for high-grade dysplasia with postoperative diagnoses,while the Japanese criteria showed the highest concordance rate for non-neoplastic lesions.The expression of P53,P504S,and Ki-67 showed significant differences(P<0.05)during the progression from normal gastric mucosa to carcinoma,whereas no significant differences were observed in the expression of C-MYC,HP,MUC5AC,and MUC6(P>0.05).Conclusion:Significant differences exist in gastric biopsy diagnosis between WHO and Japanese criteria.P53,P504S,and Ki-67 have auxiliary value in the diagnosis of early gastric cancer.The Japanese criteria,combined with immunohistochemical staining,can improve the diagnostic accuracy of high-grade dysplasia and carcinoma,providing new methods and perspectives for the diagnosis of gastric intraepithelial neoplasia,with important clinical implications.
作者
肖华静
徐嘉忆
卢德露
徐德
沈国菊
XIAO Huajing;XU Jiayi;LU Delu;XU De;SHEN Guoju(Department of Pathology,Panzhihua Central Hospital,Panzhihua 617000 Sichuan)
出处
《攀枝花学院学报》
2025年第5期110-118,共9页
Journal of Panzhihua University
基金
2022年度消化道早癌医师共同成长计划科研项目“基于病理诊断标准不同导致的胃早癌检出率差异的研究”(GTCZ-2022-SC-51-0003)。
关键词
早期胃癌
日本标准
WHO标准
免疫组化
辅助诊断
early gastric cancer
Japanese criteria
WHO criteria
immunohistochemical
auxiliary diagnosis
