活检病理胃低级别上皮内瘤变内镜下切除术后病理诊断升级相关危险因素的meta分析

A meta‑analysis of factors predicting pathological upstaging of gastric low‑grade intraepithelial neoplasia post endoscopic resection

摘要:

目的 系统评价活检病理诊断为低级别上皮内瘤变或低度异型增生的病变发生内镜下切除术后病理诊断升级的危险因素。方法 对Web of Science、Embase、PubMed和Cochrane Library数据库进行系统检索，关键词包括“Risk Factor”“Low‑Grade Dysplasia或Low‑Grade Intraepithelial Neoplasia”“gastric或stomach”，截止日期为2022年10月。收集活检病理诊断为胃低级别上皮内瘤变或低度异型增生病变而内镜下切除术后病理升级的危险因素相关的观察性研究，并行meta分析，使用随机效应模型计算合并OR值。结果 共纳入15项研究，包括5个影响因素：表面发红、病变直径、凹陷型病变、结节样表面以及病变位置。meta分析结果显示：病变表面发红（P<0.01，OR合并=2.87，95%CI：1.94~4.25）、病变直径增加（P<0.01，OR合并=2.50，95%CI：1.85~3.37）、凹陷性病变（P=0.02，OR合并=1.70，95%CI：1.09~2.64）和结节样表面（P<0.01，OR合并=2.95，95%CI：1.81~4.81）会明显增加内镜下切除术后病理诊断升级的风险；相较于胃下1/3部位病变，胃上1/3部位病变内镜下切除术后病理诊断升级的风险相似（P=0.86，OR=1.03，95%CI：0.72~1.47），而胃中1/3部位病变术后病理诊断升级的风险更低（P<0.01，OR合并=0.75，95%CI：0.60~0.93）。结论 病变直径、部位及表面形态等内镜下特征是活检病理诊断胃低级别上皮内瘤变或低度异型增生发生内镜下切除术后病理诊断升级的危险因素，临床需警惕较大、胃下1/3部位、表面发红、凹陷型、结节样表面病变发生内镜下切除术后病理诊断升级的风险。

Abstract:

Objective To identify the risk factors that predict pathological upstaging of low-grade intraepithelial neoplasia (LGIN) or low-grade dysplasia (LGD) in forceps biopsy after endoscopic resection. Methods A systematic search of Web of Science, Embase, PubMed and Cochrane Library was conducted using the terms "Risk Factor" "Low-Grade Dysplasia or Low-Grade Intraepithelial Neoplasia" "gastric or stomach" with a deadline of October 2022. Observational studies related to risk factors for biopsy pathology diagnosis of gastric LGIN or LGD lesions with pathology escalation after endoscopic resection were included. Meta-analysis was performed using random-effects models to calculate pooled odds ratio (OR). Results Fifteen studies were identified on pathologic upstaging associated with 5 different risk factors: erythema, lesion diameter, depressed lesions, nodularity, and lesion location. Factors that significantly increase the risk of upgrading the pathological diagnosis after endoscopic resection included erythema (P<0.01, OR=2.87, 95%CI: 1.94‑4.25), lesion diameter (P<0.01, OR=2.50, 95%CI: 1.85‑3.37), depressed morphology (P=0.02, OR=1.70, 95%CI: 1.09‑2.64), and nodularity (P<0.01, OR=2.95, 95%CI: 1.81‑4.81). The risk of pathologic diagnostic escalation after endoscopic resection was similar for lesions in the upper 1/3 of the stomach compared to lesions in the lower 1/3 of the stomach (P=0.86, OR=1.03, 95%CI: 0.72-1.47), whereas the risk of pathologic diagnostic escalation for lesions in the middle 1/3 of the stomach was even lower (P<0.01,OR=0.75, 95%CI: 0.60-0.93).Conclusion Several endoscopic factors, including lesion diameter, location and surface morphology, are associated with the pathologic upstaging of LGIN/LGD on pre-treatment forceps biopsy. Clinical attention should be paid to the risk of pathological diagnosis upgrading after endoscopic resection of large lesions, including redness, depression, and nodular surface lesions in the lower 1/3 of the stomach.