亚甲蓝染色透光法在早期胃癌内镜黏膜下剥离术标本诊断中的价值

Diagnostic efficacy of methylene blue staining combined with light transmission method in endoscopic submucosal dissection samples of early gastric cancer

摘要:

目的 探讨亚甲蓝染色透光方法（以下简称透光染色法）在早期胃癌内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）标本诊断中的价值。方法 选取2021年10月至2023年8月首都医科大学附属北京友谊医院早期胃癌ESD标本进行回顾性研究，75例通过透光染色法取材，即在体视显微镜下先后进行放大观察及透光染色法观察，对比两种方法对病变边界线（demarcation line，DL）、不规则微血管结构（irregular microvascular pattern，IMVP）及不规则表面微结构（irregular microsurface pattern，IMSP）的显示情况及不同组织学类型间的差异。进一步，以88例传统方法取材病理结果为对照，分析切缘假阳性率、未分化癌发现率、多灶病变发现率之间是否有差异。结果 透光染色法显示DL、IMVP及IMSP［96.0%（72/75），89.3%（67/75），98.7%（74/75）］均优于放大观察［72.0%（54/75），6.7%（5/75），26.7%（20/75）］（χ2=8.036，P<0.001；χ2=0.640，P<0.001；χ2=0.369，P<0.001）。分化型、未分化型及混合型病变之间内镜下病变符合率差异无统计学意义［92.2%（59/64）、50.0%（1/2）、77.8%（7/9），χ2=5.145，P=0.055］。与88例传统方法取材病例相比，透光染色法可提高未分化癌发现率［14.7%（11/75）比4.5%（4/88），χ2=4.964，P=0.026］，减少切缘假阳性率［1.3%（1/75）比11.4%（10/88），χ2=4.585，P=0.032］，但多灶病变发现率差异无统计学意义［5.3%（4/75）比0.0%（0/88），χ2=2.841，P=0.094］。结论 透光染色法通过显示病变DL、IMVP及IMSP，提高病理医师取材过程中对病变的识别，更易发现未分化癌、减少切缘假阳性。

Abstract:

Objective To explore the diagnostic efficacy of methylene blue staining combined with light transmission method (termed as light transmission and staining) in endoscopic submucosal dissection (ESD) specimens of early gastric cancer. Methods A retrospective study was conducted on 75 specimens of early gastric cancer treated with ESD at Beijing Friendship Hospital, Capital Medical University from October 2021 to August 2023. Under a stereomicroscope, magnified observation and transmitted light transmission and staining observation were performed to compare the demarcation line (DL), irregular microvascular pattern (IMVP) and irregular microsurface pattern (IMSP) of the lesion, and the differences among histological types were compared. Furthermore, the false positive rate of surgical margin, the detection rate of undifferentiated cancer and multifocal lesions were compared against the 88 controls processed by traditional method. Results Using the light transmission and staining method, DL, IMVP and IMSP were detected in 96.0% (72/75), 89.3% (67/75), and 98.7% (74/75), which was higher than 72.0% (54/75), 6.7% (5/75), and 26.7% (20/75) by using the magnified observation (χ2=8.036, P<0.001; χ2=0.640, P<0.001; χ2=0.369, P<0.001). There was no statistical difference in the coincidence rate of endoscopy and pathology between differentiated type, undifferentiated type and mixed type [92.2% (59/64), 50.0% (1/2), 77.8% (7/9), χ2=5.145, P=0.055]. Compared to traditional methods, light transmission and staining could increase the detection rate of undifferentiated cancer [14.7% (11/75) VS 4.5% (4/88), χ2=4.964, P=0.026] and reduce the false positive rate of surgical margins [1.3% (1/75) VS 11.4% (10/88), χ2=4.585, P=0.032], but showed no statistical difference in the detection rate of multifocal lesions [5.3% (4/75) VS 0.0% (0/88), χ2=2.841, P=0.094]. Conclusion Light transmission and staining enhances pathological recognition of DL, IMVP and IMSP during specimen processing, improving detection of undifferentiated cancer and reducing false positive of margin.