结直肠肿瘤表面凹陷形态对判断病变性质及浸润深度的作用

目的评估应用放大色素内镜观察结直肠肿瘤表面凹陷形态判断病灶性质和浸润深度的作用。方法连续收集符合内镜黏膜切除术（EMR）指征的无蒂或平坦、凹陷型病灶。应用放大色素内镜，对伴有中央凹陷的病灶根据凹陷面形态分为1型（星芒状）和2型（圆盘形）。根据EMR术后病理诊断，分析病灶表面凹陷形态与病变性质和浸润深度的相关性。结果EMR切除病灶90个（无蒂型25个，平坦、凹陷型65个）。病灶中央有凹陷者占54．4％（49／90），出现高度异型增生（HGD）或癌的比例（51．0％）显著高于没有凹陷者（17．1％）（P〈0．001）。其中，2型凹陷出现HGD或癌的比例（89．5％）又显著高于1型凹陷（26．7％、）（P〈0．001）。根据凹陷面形态区分黏膜下浅层（m·sm1）和黏膜下深层（sm2-sm3）浸润的总体准确性为83．7％（41／49）。结论根据结直肠平坦、凹陷型和无蒂肿瘤表面凹陷形态能够判断病变程度和浸润深度，从而指导EMR治疗。

Predictive value of superficial depression in estimation of histology and invasive depth of colorectal neoplasia

Objective To evaluate the predictive value of morphology of superficial depression in estimation of histology and invasive depth in colorectal neoplasia by using magnifying chromo-endoscopy.Methods Flat or depressed and sessile eolorectal lesions which were indicated for endoscopic mucosal resection (EMR) were consecutively collected. Depressed lesions were classified into type 1 (star-like) and type 2 (round) according to the morphology of depressive areas in the colorectal neoplasia with magnifying ehromoendoscopy. The relationship between morphologic classification with histology and invasive depth was studied with reference to pathological diagnosis after EMR. Results Ninety lesions including 25 sessile and 65 flat were resected with EMR. Lesions with central depression (54. 4%,49/90) were more likely to have high-grade dysplasia (HGD) or cancer than those without ( 51.0% vs. 17. 1%,P＜0. 001 ). Depressive lesions of type 2 were more susceptible to have HGD or cancer than those of type 1 (89. 5% vs. 26. 7%,P＜0. 001 ). The overall accuracy of depression morphology for distinction between lesions of superficial submueosal (m-sm1) and deep submucosal (sm2-sm3) invasion was 83. 7% (41/49). Conclusion The morphology of superficial depression on colorectal neoplasia is highly correlated with the histology and invasive depth,which facilitates the EMR treatment.