表浅食管癌内镜黏膜下剥离术切除标本碘不染区与肿瘤病理大小一致性的研究

Consistency between iodine‑unstained area and tumor pathological size of endoscopic submucosal dissection specimen in superficial esophageal cancer

摘要:

目的 比较表浅食管癌内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）切除标本的碘不染区与病理大小相符合的情况。方法 纳入2019年5月—2020年4月在浙江大学医学院附属第一医院接受ESD治疗的32例表浅食管癌患者资料进行回顾性分析。比较碘不染区与肿瘤病理区域的最大横径和最大纵径，大小均相差≤0.5 cm为相符合，任何一项相差>0.5~<1.0 cm为不符合，任何一项相差≥1.0 cm为严重不符合。同时观察喷洒卢戈液后有无粉色征以及粉色征区域与碘不染区是否一致。结果 最终32例患者33个病灶入组，包括男23例、女9例，年龄（59.5±7.3）岁。有19个（57.6%）病灶的碘不染区与肿瘤病理区域大小相符合。这19个病灶粉色征均阳性，且粉色征区域与碘不染区重叠。另有4个（12.1%）病灶碘不染区与肿瘤病理区域大小不符合，10个（30.3%）病灶碘不染区与肿瘤病理区域的大小严重不符合。这14个（42.4%）病灶粉色征均阳性，且粉色征区域均明显小于碘不染区。在14个不相符合病灶中，2个病灶根据碘不染区确定病变范围进行ESD后，因切除范围过广，术后出现狭窄。结论 ESD术前通过碘不染区确定表浅食管癌的病变范围，有可能导致病灶切除范围过广，这与病灶的碘不染区有时明显大于粉色征区域相关。因此为实现精准治疗，内镜医师可以选择碘不染并且粉色征阳性的区域为首选切除目标。

Abstract:

Objective To investigate the consistency between the iodine‑unstained area and the pathological size of endoscopic submucosal dissection (ESD) specimens of superficial esophageal cancer. Methods A retrospective study was performed on data of 32 patients with superficial esophageal cancer who accepted ESD from May 2019 to April 2020 in the First Affiliated Hospital, Zhejiang University School of Medicine. The maximum transverse diameter and maximum longitudinal diameter of the iodine‑unstained area were compared with the tumor pathological area. A size difference no more than 0.5 cm was considered as conformity, any difference between 0.5 and 1.0 cm was considered as non‑conformity, and any difference no less than 1.0 cm was considered as serious non‑conformity. At the same time, pink sign after spraying Lugo solution and the consistency of pink sign area with the iodine free area were observed. Results A total of 32 patients with 33 lesions were enrolled in this study, including 23 males and 9 females and the age of the patients was 59.5±7.3 years. There were 19 (57.6%) lesions whose size of iodine‑unstained area was consistent with the tumor pathological area. These 19 lesions were all positive for the pink sign, and the pink sign area overlapped with the iodine‑unstained area. In addition, 4 (12.1%) iodine‑unstained areas of the lesions did not match the size of the pathological area, and 10 (30.3%) iodine‑unstained areas of the lesions were seriously inconsistent with the size of the pathological area. These 14 (42.4%) lesions were all positive for pink sign, and the pink sign area was significantly smaller than the iodine‑unstained area. Among the 14 discordant lesions, 2 lesions underwent ESD according to the iodine‑unstained area, which resulted in excessive resection and postoperative stenosis. Conclusion Determining the extent of superficial esophageal cancer by iodine‑unstained areas before ESD may lead to excessive resection of the lesions, which is related to the fact that the iodine‑unstained areas of the lesions are sometimes significantly larger than the pink sign areas. Therefore, in order to achieve precise treatment, endoscopists can choose the iodine‑unstained area with positive pink sign as the first choice for resection.