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【medical-news】发现高危的胃癌前病变犹如大海捞针

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这个帖子发布于12年零293天前，其中的信息可能已发生改变或有所发展。
Finding the needle in the haystack: identifying the high-risk “premalignant” gastric lesion

Richard E. Sampliner, MD

Abbreviation: NBI, narrow-band imaging
Article Outline
• Disclosure

• References

• Copyright

Is the premalignant lesion to be detected the readily recognized intestinal metaplasia or the more difficult to detect dysplasia?

In this month's Gastrointestinal Endoscopy, authors of an article from Portugal (where gastric cancer ranks as the cancer with the second-highest incidence) attempt the “external validation of a classification for methylene blue magnification chromoendoscopy in premalignant gastric lesions.”1 This article raises issues that need to be addressed: finding the premalignant lesion in the haystack of the stomach, finding the premalignant lesion in the haystack of the population and whether methylene blue with magnification is the method of choice for detection.

As the elegant methylene blue images demonstrate in this article, metaplastic and dysplastic mucosa can be identified with magnification endoscopy. Yet is the premalignant lesion the readily recognized intestinal metaplasia or the more difficult to detect dysplasia? Gastric intestinal metaplasia is a common finding in countries with a high prevalence of Helicobacter pylori infection.2 H pylori chronic active gastritis, gastric atrophy, intestinal metaplasia, and dysplasia are well-recognized sequential events in the development of intestinal-type gastric adenocarcinoma.

Dysplasia clearly represents the greatest risk for subsequent development of cancer, certainly more than gastric intestinal metaplasia. Unfortunately, methylene blue magnification chromoendoscopy detected only 1 of 3 patients with biopsy-documented dysplasia. There was greater sensitivity in identifying gastric atrophy and intestinal metaplasia, 86% and 81%, respectively. A sample of 3 patients, however, is inadequate to evaluate the sensitivity of this endoscopic method for the real-time detection of dysplasia.

The patients in this study also are an example of the difficulty of defining the at-risk population in the haystack of adults in a country. Although 9 of the 42 patients had prior endoscopic removal of a gastric neoplastic lesion, only 3 had dysplasia. This study highlights the problem of “validating” a technique in a cross-sectional study that may be more representative of a screening population and appropriate to investigate. The problem is the low prevalence of the premalignant lesion being assessed (ie, dysplasia in gastric intestinal metaplasia). The low histologic yield of dysplasia was in spite of biopsies of standard locations (antrum, incisura, and body) and targeted biopsies of methylene blue stained and unstained areas. A total of more than 11 biopsy specimens were taken per patient. This imaging technique will not be applicable to a lower-risk population (for gastric intestinal metaplasia and dysplasia), such as the population in the United States.3

Turning to the chromoendoscopy technique: chromoendoscopy is a disappearing art in the era of high-resolution endoscopy and narrow-band imaging (NBI).4 With the ready availability of NBI in the United States, chromoendoscopy is unlikely to be used. NBI is more available than magnification endoscopy, although it is not yet validated as a technique. In the study of Areia et al,1 a median of 11 minutes was spent on methylene blue staining and 5 minutes for magnification. Such extended time at endoscopy must be justified by a high and important yield, and this will not be possible for dysplasia in gastric intestinal metaplasia. The 1% concentration of methylene blue used in this study is double that used in the United States.5 This is especially an issue given the concern raised about DNA damage.6 Additionally, this imaging technique does not have adequate performance characteristics to provide a short cut for defining a high-risk patient subgroup.

Although theoretically methylene blue staining provides the red flag technology for intestinal metaplasia, as demonstrated in the images, the dysplastic areas are less intensely stained and are apparently viewed with higher magnification. We need more sensitive, user-friendly, and less time-intense techniques to identify those at greatest risk of gastric adenocarcinoma for early endoscopic intervention or chemoprevention.
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2008-06-30 19:40 浏览 : 914 回复 : 3
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本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。
2008-07-04 22:12
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  • • 医生擅自在外执业，定期考核将不合格！甘肃省卫健委发文
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Finding the needle in the haystack: identifying the high-risk “premalignant” gastric lesion
大海捞针：寻找胃癌高危癌前病变
Richard E. Sampliner, MD

Abbreviation: NBI, narrow-band imaging
简写：NBI，窄带成像
Article Outline
• Disclosure

• References

• Copyright
文章大纲：开题 参考 版权
Is the premalignant lesion to be detected the readily recognized intestinal metaplasia or the more difficult to detect dysplasia?
公认的肠化生或更难发现的异型增生是否做为癌前病变得到检测？

In this month's Gastrointestinal Endoscopy, authors of an article from Portugal (where gastric cancer ranks as the cancer with the second-highest incidence) attempt the “external validation of a classification for methylene blue magnification chromoendoscopy in premalignant gastric lesions.”
在这个月的胃肠内镜会议上，一位来自葡萄牙（胃癌在该国的肿瘤发生率上排第二）的作者尝试进行“外部确认”，该分类在胃癌前病变中使用亚甲蓝放大染色内窥镜法。
1 This article raises issues that need to be addressed: finding the premalignant lesion in the haystack of the stomach, finding the premalignant lesion in the haystack of the population and whether methylene blue with magnification is the method of choice for detection.
该文章引起了对一些观点的讨论：在整个胃中寻找癌前病变、在茫茫人海中寻找癌前病变以及亚甲蓝扩***能否成为寻找病变的方法。

As the elegant methylene blue images demonstrate in this article, metaplastic and dysplastic mucosa can be identified with magnification endoscopy.
正如这篇文章中展示的精彩亚甲蓝图像，可以通过放大内镜分辨出粘膜化生和不典型增生。
Yet is the premalignant lesion the readily recognized intestinal metaplasia or the more difficult to detect dysplasia?
然而癌前病变是已经公认的肠化生还是更难于探及的不典型增生。
Gastric intestinal metaplasia is a common finding in countries with a high prevalence of Helicobacter pylori infection.
胃的肠化生在幽门螺杆菌高感染率的国家普遍存在。
2 H pylori chronic active gastritis, gastric atrophy, intestinal metaplasia, and dysplasia are well-recognized sequential events in the development of intestinal-type gastric adenocarcinoma.
2、在肠型胃腺癌的发展过程中，普遍认为幽门螺杆菌顺序引起胃炎、胃萎缩、肠化生和不典型增生。

Dysplasia clearly represents the greatest risk for subsequent development of cancer, certainly more than gastric intestinal metaplasia.
非典型增生显然是肿瘤发生的最大危险因素，超过了肠化生。
Unfortunately, methylene blue magnification chromoendoscopy detected only 1 of 3 patients with biopsy-documented dysplasia.
遗憾的是，亚甲蓝扩增染色内镜法仅探及3个经组织学证实的非典型增生患者中的1个。
There was greater sensitivity in identifying gastric atrophy and intestinal metaplasia, 86% and 81%, respectively.
而对胃萎缩和肠化生的敏感性更高，分别为86％和81％。
A sample of 3 patients, however, is inadequate to evaluate the sensitivity of this endoscopic method for the real-time detection of dysplasia.
然而，相对于实际非典型增生探测的操作，3个病人的样本研究来评估该内镜方法的敏感性还不充分。

The patients in this study also are an example of the difficulty of defining the at-risk population in the haystack of adults in a country.
该研究中的患者也是在一个国家成人中寻找危险人群的例子。
Although 9 of the 42 patients had prior endoscopic removal of a gastric neoplastic lesion, only 3 had dysplasia.
虽然对42名患者中的9名进行了胃癌病变的内镜切除，但只有3名有非典型增生。
This study highlights the problem of “validating” a technique in a cross-sectional study that may be more representative of a screening population and appropriate to investigate.
该研究突出反映了在代表性研究中如何“验证”一项技术的问题，这可能比筛查人群和适于调查更具有代表性。
The problem is the low prevalence of the premalignant lesion being assessed (ie, dysplasia in gastric intestinal metaplasia). 该问题是评估低流行癌前病变（如，胃肠化生中的非典型增生）。
The low histologic yield of dysplasia was in spite of biopsies of standard locations (antrum, incisura, and body) and targeted biopsies of methylene blue stained and unstained areas.
非典型增生的组织学低表达，不因标准解剖部位活检（窦部、切迹和体部）和亚甲蓝染色、非染色区域目标活检改变。
A total of more than 11 biopsy specimens were taken per patient. This imaging technique will not be applicable to a lower-risk population (for gastric intestinal metaplasia and dysplasia), such as the population in the United States.
从每个病人都取得了至少11样组织学标本。这项影像技术将不会在低危险因素人口中使用（指胃肠化生和非典型增生），如美国民众。

3Turning to the chromoendoscopy technique: chromoendoscopy is a disappearing art in the era of high-resolution endoscopy and narrow-band imaging (NBI).
3、关于染色内镜技术：在高分辨率内窥镜检查和窄带成像技术（NBI）时代，染色内镜是一项正消失的艺术。

4 With the ready availability of NBI in the United States, chromoendoscopy is unlikely to be used.
由于NBI在美国已经得到了使用，染色内窥镜技术不太可能得到应用。
NBI is more available than magnification endoscopy, although it is not yet validated as a technique.
虽然NBI还没有被证实为一种技术，但比起放大内镜技术更有用，
In the study of Areia et al,1 a median of 11 minutes was spent on methylene blue staining and 5 minutes for magnification.
在Areia等人的研究中，亚甲蓝染色的中位时间是11分钟，放大时间为5分钟。
Such extended time at endoscopy must be justified by a high and important yield, and this will not be possible for dysplasia in gastric intestinal metaplasia.
这些内镜延长时间必须得到重要高收益的证实，然而这在胃肠化生的非典型增生中不可能实现。
The 1% concentration of methylene blue used in this study is double that used in the United States.
这项研究使用1％的亚甲蓝浓度，在美国使用两倍的浓度。
5 This is especially an issue given the concern raised about DNA damage.
5、考虑到日益受到关注的DNA损失，这可能是一项特别的结果。
6 Additionally, this imaging technique does not have adequate performance characteristics to provide a short cut for defining a high-risk patient subgroup.6、另外，这项成像技术没有充分的性能特点，无法提供进行高危分组的捷径。

Although theoretically methylene blue staining provides the red flag technology for intestinal metaplasia, as demonstrated in the images, the dysplastic areas are less intensely stained and are apparently viewed with higher magnification.
虽然如图像上所显示的，亚甲蓝从理论上为肠化生提供了红色标记技术，但不典型增生区域染色浅，更容易通过高放大率来显示。
We need more sensitive, user-friendly, and less time-intense techniques to identify those at greatest risk of gastric adenocarcinoma for early endoscopic intervention or chemoprevention.
我们需要更敏感、更易操作和更省时间的技术来鉴别具有高危胃腺癌风险人群，以便早期内镜干预或化学药物预防。
2008-07-06 16:34
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大海捞针：寻找胃癌高危癌前病变
Richard E. Sampliner, MD
简写：NBI，窄带成像

文章大纲：开题 参考 版权
公认的肠化生或更难发现的异型增生是否做为癌前病变得到检测？在这个月的胃肠内镜会议上，一位来自葡萄牙（胃癌在该国的肿瘤发生率上排第二）的作者尝试进行“外部确认”，该分类在胃癌前病变中使用亚甲蓝放大染色内窥镜法。
1、该文章引起了对一些观点的讨论：在整个胃中寻找癌前病变、在茫茫人海中寻找癌前病变以及亚甲蓝扩***能否成为寻找病变的方法。

正如这篇文章中展示的精彩亚甲蓝图像，可以通过放大内镜分辨出粘膜化生和不典型增生。然而癌前病变是已经公认的肠化生还是更难于探及的不典型增生。胃的肠化生在幽门螺杆菌高感染率的国家普遍存在。
2、在肠型胃腺癌的发展过程中，普遍认为幽门螺杆菌顺序引起胃炎、胃萎缩、肠化生和不典型增生。非典型增生显然是肿瘤发生的最大危险因素，超过了肠化生。遗憾的是，亚甲蓝扩增染色内镜法仅探及3个经组织学证实的非典型增生患者中的1个。而对胃萎缩和肠化生的敏感性更高，分别为86％和81％。然而，相对于实际非典型增生探测的操作，3个病人的样本研究来评估该内镜方法的敏感性还不充分。

该研究中的患者也是在一个国家成人中寻找危险人群的例子。虽然对42名患者中的9名进行了胃癌病变的内镜切除，但只有3名有非典型增生。该研究突出反映了在代表性研究中如何“验证”一项技术的问题，这可能比筛查人群和适于调查更具有代表性。该问题是评估低流行癌前病变（如，胃肠化生中的非典型增生）。非典型增生的组织学低表达，不因标准解剖部位活检（窦部、切迹和体部）和亚甲蓝染色、非染色区域目标活检改变。从每个病人都取得了至少11样组织学标本。这项影像技术将不会在低危险因素人口中使用（指胃肠化生和非典型增生），如美国民众。
3、关于染色内镜技术：在高分辨率内窥镜检查和窄带成像技术（NBI）时代，染色内镜是一项正消失的艺术。
4、由于NBI在美国已经得到了使用，染色内窥镜技术不太可能得到应用。虽然NBI还没有被证实为一种技术，但比起放大内镜技术更有用。在Areia等人的研究中，亚甲蓝染色的中位时间是11分钟，放大时间为5分钟。这些内镜延长时间必须得到重要高收益的证实，然而这在胃肠化生的非典型增生中不可能实现。这项研究使用1％的亚甲蓝浓度，在美国使用两倍的浓度。
5、考虑到日益受到关注的DNA损失，这可能是一项特别的结果。
6、另外，这项成像技术没有充分的性能特点，无法提供进行高危分组的捷径。

虽然如图像上所显示的，亚甲蓝从理论上为肠化生提供了红色标记技术，但不典型增生区域染色浅，更容易通过高放大率来显示。我们需要更敏感、更易操作和更省时间的技术来鉴别具有高危胃腺癌风险人群，以便早期内镜干预或化学药物预防。

（对该专业不是很熟悉，不少可能需要改正，请高手指导了）
2008-07-06 16:40
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