将活检标本的组织学检查作为诊断“金标准”的局限性：一个例子

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食管腺癌是胃肠道最常见的恶性肿瘤之一。为了在早期阶段发现这种疾病，医生采用内窥镜、形态学、免疫组化等检查方法。但是，这些方法不仅需要使用高度专业化的设备，还取决于内镜医师和病理形态学医师的专业水平。

本文描述了对一名进行性吞咽困难患者的临床观察。吞咽困难是由食道肿瘤引起的。肿瘤已扩散到胃的贲门下段。肿瘤在一年内无法进行病理形态学验证。在居住地医疗机构进行的食管胃十二指肠镜检查、电子计算机断层扫描和食管双对比透视检查的数据证实了肿瘤的恶性程度。然而，大量组织学检查的结果都支持幽门腺腺瘤、顶体腺瘤或带有高度上皮发育不良病灶的肿瘤细胞腺瘤。在专业机构的条件下，通过内窥镜检查和靶向活检，才有可能证实肿瘤的恶性程度。

研究结果表明，在病理形态学检查数据相互矛盾的情况下，临床表现和仪器方法对最终诊断的重要。这再次提出活检标本的组织学检查作为诊断恶性肿瘤“金标准”的局限性问题。

作者简介

Dina A. Akhmedzyanova

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

编辑信件的主要联系方式.
Email: AkhmedzyanovaDA@zdrav.mos.ru
ORCID iD: 0000-0001-7705-9754
SPIN 代码: 6983-5991
Scopus 作者 ID: 58104960900
俄罗斯联邦, Moscow

Olga K. Yutsevich

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Research Radiological Center

Email: o.yutsevitch@yandex.ru
ORCID iD: 0000-0002-3860-9853
俄罗斯联邦, Moscow

Roman V. Reshetnikov

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: r.reshetnikov@npcmr.ru
ORCID iD: 0000-0002-9661-0254
SPIN 代码: 8592-0558

Cand. Sci. (Phys.-Math.)

俄罗斯联邦, Moscow

Olga V. Tashchyаn

The First Sechenov Moscow State Medical University

Email: olgatash1@rambler.ru
ORCID iD: 0000-0001-6759-6820
SPIN 代码: 3658-1120

MD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow

Sergey S. Pirogov

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Research Radiological Center

Email: pirogov@mail.ru
ORCID iD: 0000-0002-8101-2155
SPIN 代码: 7812-5502

MD, Dr. Sci. (Med.)

俄罗斯联邦, Moscow

Maria P. Mazurova

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Research Radiological Center

Email: mnioi_morphology@mail.ru
ORCID iD: 0000-0002-4873-4455
SPIN 代码: 4455-3055

MD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow

Nadezhda N. Volchenko

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Research Radiological Center

Email: mnioi_morphology@mail.ru
ORCID iD: 0000-0003-0421-4172

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Moscow

Aziz K. Kamalov

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Research Radiological Center

Email: kak6768@mail.ru
ORCID iD: 0000-0001-7376-6056
SPIN 代码: 1671-1600
俄罗斯联邦, Moscow

Yuliya F. Shumskaya

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: ShumskayaYF@zdrav.mos.ru
ORCID iD: 0000-0002-8521-4045
SPIN 代码: 3164-5518
俄罗斯联邦, Moscow

Marina G. Mnatsakanyan

The First Sechenov Moscow State Medical University

Email: mnatsakanyan08@mail.ru
ORCID iD: 0000-0001-9337-7453
SPIN 代码: 2015-1822

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Moscow

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补充文件

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1. JATS XML
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2. 图1。食道的射线照相。食道呈环形狭窄，钡胶浆通道较细（箭头所示）。

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3. 图2。胸部器官的计算机断层扫描。白色箭头表示病理变化：a——食道肿瘤，延伸至胃贲门部位，长186mm；b——肿瘤组织大量增生，食道中三分之一处的管腔狭窄；c——区域主动脉旁淋巴结的肿瘤病变；d——食道下三分之一处的管腔狭窄达到2mm。

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4. 图3。内窥镜照片。巴雷特食管引起的狭窄性腺癌。蓝色箭头表示肿瘤呈环状分布的区域。

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5. 图4。内窥镜照片。巴雷特食管引起的狭窄性腺癌。黄色箭头表示胃入口处的内窥镜，绿色箭头表示肿瘤组织。

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