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目的 对“消化道内镜黏膜下层剥离术(endoscopic submucosal dissection,ESD)标本取材规范”进行改进,并提出精确显示高级别上皮内瘤变(high grade intraepithelial neoplasia,HGEIN)早期浸润的方法.方法 建立一种“全切缘显示”的ESD标本取材法,应用于120例消化道ESD标本.用0.05％24型蛋白酶消化40 min修复的Ⅳ型胶原免疫组化染色,观察HGEIN基底膜是否完整,判断有无早期浸润.对患者性别、年龄、病变的部位、肉眼分型、组织学类型、切缘侵犯情况等进行统计分析,以判断该取材法的临床实用性.结果 食管30例、胃64例、肠26例;男性70例,女性50例,年龄23-81岁,平均58岁.肉眼分型:I型42例,ⅡA型43例,ⅡB型29例,ⅡC型6例.组织学类型:HGEIN39例;癌变17例,其中3例为M1,5例为M2,6例为M3,3例为SM2.HGEIN有2例口端切缘侵犯.8例疑癌变标本,通过Ⅳ型胶原标记后6例证实为HGEIN,2例为癌变.结论 “全切缘显示”ESD标本病理检查方法,不仅上下切缘及两侧切缘都可以完整显示,且不增加工作量,无需大包埋盒和平推式滑动切片机等专用设备.对于HGEIN疑癌病例用Ⅳ型胶原免疫组化染色显示早期癌浸润效果佳.“,”AIM To improve the technique of pathological sampling of digestive tract specimens during endoscopic submucosal dissection (ESD),and establish a way of precisely displaying high level intraepithelial neoplasia (HGEIN) with early infiltration.METHODS A full incisal margin dissection method was established and then applied to 120 digestive tract ESD specimens.Immunohistochemical staining for type IⅣ collagen was performed to observe whether the basement-membrane in HGEIN was complete and whether there was early infiltration or not.Data including gender,age,anatomic site,macroscopic classification,histology,and incisal margin infringement were analyzed.RESULTS The study group consisted of 70 males and 50 females with ages ranging from 23 to 81 years (mean,58 years).There were 30 esophageal cases,64 stomach cases,and 26 colon cases of ESD specimens.With regard to macroscopic classification,there were 42 type Ⅰ cases,43 type ⅡA,29 type ⅡB,and 6 type ⅡC.Pathological examinations revealed 39 cases of HGEIN and 17 cases of cancer (including 3 M1 cases,5 M2 cases,6 M3 cases,and 3 SM2 cases).There were two HGEIN cases that were incisal margin positive.For 8 suspected cancer cases in the HGEIN group,immunohistochemical staining for type Ⅳ collagen revealed that 6 cases were HGEIN,and the other two cases were cancer.CONCLUSION The full incisal margin dissection method for ESD specimens allows to display the full incisal margins,without increasing workload or requiring large embedding box and horizontal pushing type sliding slicer.For HGEIN cases suspected of being cancer,immunohistochemical staining for type Ⅳ collagen could reveal early infiltration well.