胃黏膜病变内镜黏膜下剥离术后病理升级的相关因素分析

Background Early diagnosis of gastric cancer is essential for patient prognosis. Currentlyendoscopic forceps biopsyEFB is an important tool for the diagnosis of gastric cancer. Howeverit has been shown in relevant studies that there are some differences between EFB-based diagnosis and pathological diagnosis after endoscopic submucosal dissectionESDresulting in an underestimation of the patient's condition. No related research has been conducted in northern Shaanxi. ObjectiveTo calculate the rate of pathological upgrading in gastric mucosal lesions after ESD in five hospitals in northern Shaanxiand to analyze the factors associated with pathological upgrading. MethodsWe recruited patients with gastric mucosal lesions who underwent ESD following EFB in five hospitalsYan'an University Affiliated HospitalYan'an People's HospitalThe First Hospital of YulinYan'an Traditional Chinese Medicine HospitalZichang People's Hospital from January 12016 to December 302021. We classified the pathological results of gastric mucosal lesions into the following categorieschronic gastric inflammatory changesCIClow-grade gastric intraepithelial neoplasiaLGINhigh-grade gastric intraepithelial neoplasiaHGINearly gastric cancerEGC and progressive gastric cancer. The difference between EFBbased diagnosis and pathological diagnosis of ESD specimens was analyzed. Pathological upgrading was defined as progression in pathological results. The pathological upgrading in patients with CICLGIN or HGIN was counted. The factors associated with pathological upgrading were analyzed. ResultsA total of 241 patients were included. Seventy-six31.5% were found with pathological upgrading after ESD compared with their EFB-based diagnoses. Binary logistic regression analysis showed that endoscopic classification OR=0.13495%CI0.0290.617 and superficial ulceration OR=3.59595%CI1.22610.536 were associated with pathological upgrading in CIC P<0.05. Age OR=3.96195%CI1.07114.650endoscopic classification OR=0.31195%CI0.1270.765redness of mucosal surface OR=5.83095%CI1.591 21.355and number of specimens OR=0.23495%CI0.0630.872 were associated with pathological upgrading in LHIN P<0.05. Lesion size OR=3.14395%CI 1.0039.852 was associated with pathological upgrading in HGIN P<0.05.ConclusionMedical workers should be alert to the potential possibility of underestimated pathology in EFB if the lesion is CIC suggested by EFB but is endoscopically classified as flat or concave with surface ulceration. And the potential possibility is also should be considered if there is only one biopsy specimen obtained from a patient aged greater than 60 yearsand the lesion is LGIN suggested by EFBbut is endoscopically classified as flat with redness of mucosal surfaceand an ESD can be underwent if necessary. Moreoverif a lesion greater than 2 cm in size is HGIN suggested by EFBwhich is probably EGCand an ESD is recommended to verify it.