본 연구는 고양이 십이지장에서 내시경적 조직 생검 시 사용된 다양한 겸자의 특징에 따른 조직의 질과 조직병리학적 적합성에 대해 평가하였다. 이러한 내시경용 생검 겸자에 따른 조직의 질과 적합성에 대한 연구는 인의에서 다수 보고되었으며 최근 개에서의 연구가 보고되었으나 고양이에서의 연구는 진행되지 않았다. 따라서 본 연구에서는 기존의 연구 결과와 고양이에서의 결과를 비교하여 그 차이를 확인하고자 하였다. 총 3마리의 건강한 고양이의 십이지장에서 3가지 종류의 생검 겸자를 사용하여 두 명의 실험자가 각각의 겸자 당 5 개씩의 시료를 채취하여 총 90개의 십이지장 점막 조직을 획득하였다. 획득한 조직은 각각 무게와 길이, 깊이, 부서진 인공구조, 조직병리학적 적합성에 대해 평가하였다. 내시경 생검용 겸자에 의한 조직의 질은 컵이 큰 겸자의 경우 더 무겁고 긴 조직을 얻는데 효과적인 결과를 얻었으며 이는 기존의 사람과 개에서의 연구와 비슷하다. 그러나 조직의 깊이와 부서진 인공구조, 특히 조직병리학적 적합성에 있어서는 겸자의 컵 크기나 모양에 따른 차이가 나타나지 않았으며 이는 기존의 연구와 다른 점이다. 하지만 조직학적 적합성이 있다고 평가된 조직들은 길이가 길고 인공구조가 적게 나타났으며 이러한 조직의 질은 겸자의 종류에 따른 차이를 보였다. 따라서 겸자의 종류는 조직의 질에 영향을 미치며 이는 간접적으로 조직학적 적합성과 관련이 있을 것으로 생각된다. 이를 바탕으로 고양이의 내시경적 생검 시, 비록 작은 컵의 겸자로도 조직병리학적으로 적합한 조직을 얻을 수 있지만 더 나은 질의 조직을 얻기 위해서 큰 컵의 겸자를 적용하는 것이 효과적인 것으로 생각된다.
본 연구는 고양이 십이지장에서 내시경적 조직 생검 시 사용된 다양한 겸자의 특징에 따른 조직의 질과 조직병리학적 적합성에 대해 평가하였다. 이러한 내시경용 생검 겸자에 따른 조직의 질과 적합성에 대한 연구는 인의에서 다수 보고되었으며 최근 개에서의 연구가 보고되었으나 고양이에서의 연구는 진행되지 않았다. 따라서 본 연구에서는 기존의 연구 결과와 고양이에서의 결과를 비교하여 그 차이를 확인하고자 하였다. 총 3마리의 건강한 고양이의 십이지장에서 3가지 종류의 생검 겸자를 사용하여 두 명의 실험자가 각각의 겸자 당 5 개씩의 시료를 채취하여 총 90개의 십이지장 점막 조직을 획득하였다. 획득한 조직은 각각 무게와 길이, 깊이, 부서진 인공구조, 조직병리학적 적합성에 대해 평가하였다. 내시경 생검용 겸자에 의한 조직의 질은 컵이 큰 겸자의 경우 더 무겁고 긴 조직을 얻는데 효과적인 결과를 얻었으며 이는 기존의 사람과 개에서의 연구와 비슷하다. 그러나 조직의 깊이와 부서진 인공구조, 특히 조직병리학적 적합성에 있어서는 겸자의 컵 크기나 모양에 따른 차이가 나타나지 않았으며 이는 기존의 연구와 다른 점이다. 하지만 조직학적 적합성이 있다고 평가된 조직들은 길이가 길고 인공구조가 적게 나타났으며 이러한 조직의 질은 겸자의 종류에 따른 차이를 보였다. 따라서 겸자의 종류는 조직의 질에 영향을 미치며 이는 간접적으로 조직학적 적합성과 관련이 있을 것으로 생각된다. 이를 바탕으로 고양이의 내시경적 생검 시, 비록 작은 컵의 겸자로도 조직병리학적으로 적합한 조직을 얻을 수 있지만 더 나은 질의 조직을 얻기 위해서 큰 컵의 겸자를 적용하는 것이 효과적인 것으로 생각된다.
Based on the results of previous studies, endoscopic biopsy sample's quality has a major impact on its adequacy for histopathology, and that the nature of the biopsy forceps can influence the specimen quality. The present study compared the effects of three different types of endoscopic biopsy force...
Based on the results of previous studies, endoscopic biopsy sample's quality has a major impact on its adequacy for histopathology, and that the nature of the biopsy forceps can influence the specimen quality. The present study compared the effects of three different types of endoscopic biopsy forceps and two different operators on sample quality and adequacy for histopathology in three healthy cats. Every biopsy was performed between the major papilla and caudal duodenal flexure, and each operator performed five biopsies with each type of forceps on each cat, for a total of 90 biopsies. One pathologist evaluated the quality and adequacy of the obtained samples. Biopsies performed with large-cup forceps provided heavier and longer samples than the standard round forceps. With the same size forceps, the presence of alligator teeth had no effect on sample quality or adequacy for histopathological examination and assessment. Based on the results of the present study, although the standard round forceps could be used to obtain adequate samples for histopathology, large-cup forceps such as the standard oval and alligator jaw type have the advantage of obtaining high quality endoscopic samples.
Based on the results of previous studies, endoscopic biopsy sample's quality has a major impact on its adequacy for histopathology, and that the nature of the biopsy forceps can influence the specimen quality. The present study compared the effects of three different types of endoscopic biopsy forceps and two different operators on sample quality and adequacy for histopathology in three healthy cats. Every biopsy was performed between the major papilla and caudal duodenal flexure, and each operator performed five biopsies with each type of forceps on each cat, for a total of 90 biopsies. One pathologist evaluated the quality and adequacy of the obtained samples. Biopsies performed with large-cup forceps provided heavier and longer samples than the standard round forceps. With the same size forceps, the presence of alligator teeth had no effect on sample quality or adequacy for histopathological examination and assessment. Based on the results of the present study, although the standard round forceps could be used to obtain adequate samples for histopathology, large-cup forceps such as the standard oval and alligator jaw type have the advantage of obtaining high quality endoscopic samples.
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문제 정의
Indeed, investigations of endoscopic biopsy forceps applied to humans and dogs might not be relevant to feline patients, given the differences in patient size and organ anatomy. The purpose of this study was to evaluate and compare the quality and adequacy of duodenal samples in healthy cats obtained with different types of forceps designed for gastrointestinal endoscopy for histopathological assessment, and to determine if there is any variation in specimen quality associated with different endoscopists.
제안 방법
8 mm diameter forceps (5). All forceps in this study were pediatric forceps that were insufficient for capturing the deeper layer and applying appropriate pressure at the mucosa, though the three forceps had different styles and cup sizes. It is recognized that these pediatric forceps are limited in their ability to obtain high quality samples with regard to depth.
Gastroduodenal endoscopy was performed using a flexible video endoscope (GIF XP 150N Flexible Video Endoscope; working length: 110 cm, outer diameter: 5.5 mm, working channel diameter: 2.0 mm, Olympus, Japan) with a CV-150 processor. Two different operators performed the endoscopic biopsy procedures in this study.
0. One-Way ANOVA and Mann-Whitney U tests were used to compare the sample quality (including weight, length, depth, and crush artifact) and histopathological adequacy, respectively, between the types of endoscopic forceps and the different operators. Post-hoc pairwise comparisons were examined using Tukey’s test as appropriate.
The evaluating pathologist was blinded to all information, including the identity of the endoscopist, type of biopsy forceps used, and identity of the animal.
0 mm, Olympus, Japan) with a CV-150 processor. Two different operators performed the endoscopic biopsy procedures in this study. Samples were obtained from normal-appearing duodenal mucosa between the major papilla and caudal duodenal flexure.
대상 데이터
After measuring the weight of the sample, a total of 90 vials filled with 10% formaldehyde were referred to the Pathologic Diagnosis Service of the Veterinary College of Gyeongsang National University. The tissues were embedded in paraffin and then sectioned serially 5 µm thick, and stained with hematoxylin and eosin (H&E) according to manufacturer instructions.
0-mm opened jaw with a fenestrated cup (Fig 1B-a); and the forceps with alligator jaws (FB-15K-1, Olympus, Japan) (Fig 1C) had the same opened cup size as the standard oval forceps (Fig 1C-a). All forceps used in this study were Olympus pinch biopsy forceps with 1.8-mm diameters (Fig 1), which is a smaller size than the primary forceps used in the previous studies.
성능/효과
The results of this study demonstrate the superiority of large-cup forceps. In particular, the size of the biopsy forceps cup has a significant effect on the weight and length of feline duodenal endoscopic biopsy samples, regardless of the operator.
The samples obtained with the standard oval cup forceps were significantly heavier than those obtained with the standard round cup forceps (p = 0.000), but there were no statistically significant differences between the alligator jaw type and the standard round (p = 0.072) or standard oval (p =0.199) (Table 2).
Second, our study was limited practically by the sample handling procedure in the sample submission technique, because we did not rule out variability during the unfolding process by using a needle. Third, all specimens were taken from healthy duodenal mucosa, so these results may not be applicable in other circumstances because upper gastrointestinal diseases likely result in a more fragile and friable mucosa. Finally, the endoscopic samples taken from other sites of the GI tract such as the stomach, jejunum, ileum, and colon of cats might not show the same results seen with the duodenal mucosa.
후속연구
First, the number and variety of biopsy forceps were fewer than those reported in previous studies (1,2,5,6,8,11,18,23). For a more meaningful comparison, it will be necessary to evaluate more varied forceps types (large diameter, those with a spike, disposable, different manufacturers) to determine the impact of the type of forceps on sample quality. Second, our study was limited practically by the sample handling procedure in the sample submission technique, because we did not rule out variability during the unfolding process by using a needle.
Therefore, we recommend the use of large-size cup forceps for duodenal mucosal biopsies in cats to obtain better quality specimens. In addition, further studies are needed to evaluate more forceps types and forceps effects on samples from cats with gastrointestinal disease.
In addition, fenestration was present in the cup of the standard oval forceps but not the cup of the alligator jaw forceps. Therefore, additional comparisons (fenestrated alligator jaw type versus closed alligator jaw, closed standard oval versus fenestrated standard oval) are needed to evaluate whether fenestration of the cup influences sample quality.
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