The mechanism and strategy of esophageal sampling procedure

doi:10.3969/j.issn.1004-437X.2000.04.001

Abstract：Objective: To explore the mechanism of biopsy sampling procedure in the detection of esophageal precancerous le-sions and to establish the strategies for improving reproducibility through target biopsy. Methods: Biospies were taken from themiddle-third and the lower-third of the esophagus of 28 subjects from a high incidence area of esophageal cancer in Henan,China. The sampling procedure was repeated on the same subjects 10 days later. During this period,all subjects followed theirusual dietary habits.88 symptom-free subjects from the same high incidence area for esophageal cancer in Henan, China wereexamined by endoscopy combined with iodine staining and targeted biopsy. Results: In the second sampling from the middle-third of the esophagus,24% of the subjects had less severe lesions,28% had more severe lesions and 48% had the sameseverity of lesions. In those from the lower-third of the esophagus,48% of the subjects had less severe lesions, 16% had moresevere lesions and 32% had the same severity of lesions. Statistics analysis showed that there was no difference in the propor-tions of esophageal precancerous lesions between the staining mucosa and the unstaining mucosa. Conclusion: Histologicalmophomoty analysis indicated that there were no difference in epithelial thickness among the normal tissues with different sever-ity of lesions. The biopsy sampling procedure was a key effector to influence the follow-up results of histopathology. The similarthickness among the normal tissue and the diseased tissue, (especially in the less severity lesions, which resulted in difficultiesof recognition for precancerous lesions under endoscopy )was the key mechanism for poor reproducibility. Iodine staining canimprove the recognition for the normal and diseased epithelia, however, the target biopsy for the local lesions still need to be im-proved. High reproducibility of p53 protein immunostaining indicates that p53 seems to be a promising biomarker in esophagealcarcinogenesis.