Analysis of Preoperative and Postoperative Pathology in 135 Cases of Endoscopic Submucosal Dissection

doi:10.3969/j.issn.1674-3245.2025.05.037

Abstract：Objective: By analyzing the preoperative and postoperative pathological diagnoses of endoscopic submucosal dissection (ESD) specimens of the digestive tract, this study explores the relationship between clinical and pathological diagnosis, and improves the accuracy of clinical pathology diagnosis. Methods: A retrospective analysis was conducted on 135 patients who underwent digestive ESD at the Gastrointestinal Endoscopy Center of the 988th Hospital of the Joint Logistics Support Force from June 2014 to December 2020. Using the post-ESD pathological diagnosis as the gold standard, the differences between preoperative and postoperative pathological diagnoses were compared, and the endoscopic findings and histopathological features were analyzed. Results: A total of 135 cases were included in the study, including 78 esophageal specimens, 53 gastric specimens, and 4 intestinal specimens. Of these, 111 specimens had both preoperative and postoperative pathological diagnoses. The preoperative and postoperative pathological diagnoses were completely consistent in 74 cases, with a consistency rate of 66.7% (74/111). The under-diagnosis rate was 21.6% (24/111), and the over-diagnosis rate was 11.7% (13/111). In the remaining 24 cases, only clinical diagnoses such as gastrointestinal tumors or polyps were available. There was no statistically significant difference in the consistency rate between esophageal LIN (80%, 12/15) and HIN (67.9%, 36/53) (P > 0.05). The under-diagnosis rate of esophageal HIN (32.1%, 17/53) was significantly higher than that of esophageal LIN (6.7%, 1/15), with a statistically significant difference (χ2 = 3.878, P = 0.049). There was no statistically significant difference in the consistency rate between gastric LIN (54.2%, 13/24) and HIN (81.9%, 9/11) (P > 0.05). The under-diagnosis rate of gastric LIN (16.7%, 4/24) and HIN (18.1%, 2/11) showed no statistically significant difference (P > 0.05). There was no statistically significant difference in the consistency rate between gastric and esophageal ESD (P = 0.102). Conclusion: ESD has good therapeutic effects for early lesions or small tumors in the digestive tract. There are certain under-diagnosis (LIN 6.7%, 16.7%; HIN 18.1%, 32.1%) and over-diagnosis (LIN 13.3%, 29.2%) rates in preoperative biopsy pathology for intraepithelial neoplasia in the esophagus and stomach. Pathologists should strengthen collaboration with endoscopists, continuously learn and summarize, to improve the accurate identification of intraepithelial neoplasia in the digestive tract, thereby better serving patients.