Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Comparison of Endoscopic Forcep Biopsy and the Histopathologic Diagnosis after Endoscopic Submucosal Dissection

내시경 겸자 생검과 내시경 점막하 박리술 후 획득된 조직의 병리학적 차이에 대한 고찰

Kim, Young-Dae;Cho, Joo-Young;Jung, In-Seop;Koh, Bong-Min;Hong, Su-Jin;Ryu, Chang-Beom;Kim, Jin-Oh;Lee, Joon-Seong;Lee, Moon-Sung;Jin, So-Young;Shim, Chan-Sup;Kim, Boo-Sung
김영대;조주영;정인섭;고봉민;홍수진;유창범;김진오;이준성;이문성;진소영;심찬섭;김부성

  • Published : 20090400
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Abstract

Background/Aims: The discrepancy of the histopathological diagnosis between endoscopic forcep biopsy, surgery and endoscopic mucosal resection (EMR), has been reported on in a previous study. We compared the results of endoscopic forcep biopsy and the histopathologic diagnosis after performing endoscopic submucosal dissection (ESD). Methods: We retrospectively reviewed 434 lesions for which we were able to compare the post-ESD histopathologic results with the endoscopic biopsy. Results: 1) Of the 14 lesions that showed chronic gastritis or atypia by endoscopic biopsy, 9 were diagnosed with carcinoma in situ or adenocarcinoma after ESD. 2) fifty one of 141 lesions that showed low grade dysplasia on the endoscopic biopsy were diagnosed with carcinoma in situ or adenocarcinoma after ESD. 3) Of the 60 lesions that showed high grade dysplasia on the endoscopic biopsy, 46 were diagnosis with carcinoma in situ or adenocarcinoma after ESD. Conclusions: The discrepancy of the histopathological diagnosis was found between ESD and forcep biopsy. In light of these results, if a lesion that is suspected to be EGC, although it is not diagnosed by endoscopic biopsy, then it should be confirmed by ESD.

목적: 위선종과 조기 위암에 대한 많은 연구들에서 내시경 겸자 생검의 결과와 수술이나 내시경 점막 절제술 시행 후 획득된 전체 병변의 병리학적인 진단이 상당 부분 일치하지 않음을 보고하였다. 내시경 점막 절제술에 비해 보다 넓은 병변을 절제하는 내시경 점막하 박리술에서 내시경 겸자 생검과의 병리학적인 진단의 차이를 비교 분석하였다. 대상 및 방법: 내시경 소견 및 내시경 겸자 생검에서 조기 위암이나 위선종이 의심되어 2003년 2월부터 2006년 7월까지 본원에서 내시경 점막하 박리술을 시행한 447예 중 시술 전후 조직 진단을 비교할 수 있었던 434예를 대상으로 후향적으로 분석하였다. 결과: 1) 434예 중 내시경 점막하 박리술 후 조직 진단이 변한 경우가 253예였다. 2) 시술 전 만성 위염 및 비정형성 소견을 경우는 14예 중 시술 후 상피내 암종이나 선암종으로 진단이 바뀐 경우는 9예였다. 3) 시술 전 저도 이형성증의 위선종으로 진단되었던 141예 중 시술 후 상피내암종이나 선암종으로 진단이 바뀐 경우는 51예였다. 4) 시술 전 고도 이형성증으로 진행된 위선종이 관찰되었던 60예 중 46예에서 시술 후 상피내암종이나 선암종으로 진단이 바뀌었다. 결론: 내시경 점막하 박리술에서도 수술이나 내시경 점막 절제술에 대한 기존 보고에서처럼 시술 전후 조직 진단의 차이가 관찰된다. 따라서 내시경 겸자 생검에서 악성 병변으로 확진되지 않아도 육안 소견에서 강력히 의심되는 경우 일괄 절제를 통한 전체 병변을 획득하여 정확한 조직학 진단을 하는 것이 필요하다고 생각한다.

Keywords

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