我想同學您要問的是"組織學"上的診斷差異吧未免失真,一些研究論文的整理直接給原文,希望能夠有所幫助•BE is
defined as columnar
metaplasia of the esophagus that
is visible endoscopically and confirmed histologically.–1950
by Norman
Barrett•All
doctors agree that endoscopic finding of columnar mucosa in the esophagus is
necessary to diagnose BE.
•But
the requirement for histologic confirmation is controversial.Metaplastic columnar epithelium is enoughOrNo goblets, no Barrett’s. (for the higher cancer risk)•2007
Modern Pathology
–A DNA
study of 50 patients
–(1)
Chromosomal
changes are more
frequent in nongoblet metaplasia.
–(2) The
two phenotypes
of gastric
and intestinal
are
equally
involved.•2009
Human Pathology
–A
study of 254 patients in UK
–Nongoblet
gastric-type metaplasia still has 3.6% of patients to develop
well-differentiated adenocarcinoma.•2009 The
American Journal of Gastroenterology
–A
study of 68 patients
Metaplastic
esophageal columnar
epithelium without
goblet cells shows
DNA content abnormalities
similar to
goblet cell-containing epithelium.•2012
Gut (UK)
–A database
study of 11,434 patients
–There
is still 0.19% cancer risk of nongoblet
metaplasia.•2014
Gut (UK)
–British
Society of
Gastroenterology
–Guidelines
on
the diagnosis and management of
Barrett’s oesophagus
–Barrett's
oesophagus
is defined as an oesophagus
in which any portion of the normal distal squamous epithelial
lining has been replaced by metaplastic columnar epithelium.•2011
Journal of the National Cancer Institute
–Population-based
study of 8,522 patients
–Cancer
risk:
0.07%
in patients without goblet cell
0.38% in patients with goblet cellsNo
goblets, no Barrett’s!•2011
Gastroenterology,
–American
Gastroenterological Association (AGA) medical position
statement on the
management of
Barrett’s esophagus
–Presently,
intestinal metaplasia is required for the
diagnosis of
Barrett's esophagus because intestinal metaplasia is the only type of
esophageal columnar epithelium that clearly predisposes to malignancy.•2012
The American Journal of Surgical Pathology
–A
study of 214 patients
–Columnar-lined
esophagus without
intestinal metaplasia has no proven risk of adenocarcinoma.•2012
Clinical Gastroenterology and Hepatology
–A biopsy-specimen-based
analysis of 637 patients
–Decreasing
the
requirement for goblet cells would cause many patients to be inaccurately
labeled as BE.
–No
patient without goblet cells developed adenocarcinoma.•2015
The American Journal of Enterogastrology
–A
review made by
Benign Barrett’s and Cancer
Taskforce
–Although
non-goblet metaplasia is also at risk for cancer, the risk is much lower than
the metaplasia with goblet cells.Goblet
or Nongoblet?•2015
The American Journal of Enterogastrology
–A
review made by Benign Barrett’s and Cancer Taskforce
–They
suggested
GI
physicians define BE by the endoscopic presence of
columnar mucosa
Pathology
report of biopsies of the esophagus should always state whether
goblet cells are present
•In
Taiwan: 臺灣醫界 2008, Vol.51, No.9
–GI: Endoscopically
suspected
esophageal
metaplasia
–Pathologist:
Gastric-type metaplasia; Intestinal-type metaplasia; Histologic proved
Barrett’s esophagus.