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Risk factors for under-diagnosis of gastric intraepithelial neoplasia and early gastric carcinoma in endoscopic forceps biopsy in comparison with endoscopic submucosal dissection in Chinese patients

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Abstract

Differences in pathologic diagnosis between endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) for gastric intraepithelial neoplasia (GIN) and early gastric carcinoma (EGC) in Chinese patients remain unknown. The aim of the study was to investigate risk factors for under-diagnosed pathology in initial EFB, compared to final ESD. We reviewed endoscopic and histopathologic findings for tumor location, size, macroscopic pattern, nodularity, erythema, erosion, GIN (low and high grade), and EGC diagnosed with the WHO criteria. Differences in those features between EFB and ESD were compared and risk factors for under-diagnosis by EFB were analyzed. Although concordant in most (74.9 %) cases between EFBs and ESDs, pathological diagnoses in 57 (25.1 %) cases were upgraded in ESDs. Compared to the concordant group, the lesion size ≥2 cm, and depressed and excavated patterns were significantly more frequent in the upgraded group. Further multivariate regression analysis demonstrated the depressed pattern and lesion size ≥2 cm as independent risk factors for upgraded pathology with the odds ratio of 5.778 (95 % confidence interval 2.893–11.542) and 2.535 (95 % confidence interval 1.257–5.111), respectively. Lesion size ≥2.0 cm and the depressed pattern at initial EFB were independent risk factors for pathologic upgrade to advanced diseases in ESD. Therefore, these endoscopic characteristics should be considered together with the initial EFB diagnosis to guide the optimal clinical management of patients with GIN and EGC.

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    Authors and Affiliations

    1. Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China

      Guifang Xu, Ying Lv, Bin Zhang, Tingsheng Ling, Xiaoqi Zhang, Lei Wang & Xiaoping Zou

    2. Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China

      Weijie Zhang

    3. Department of Pathology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China

      Qi Sun & Qin Huang

    4. Department of Pathology, 101 Hospital of PLA, Wuxi, China

      Zhihua Zhou

    5. Department of Pathology and Laboratory Medicine, VA Boston Healthcare System and Harvard Medical School, 1400 VFW Parkway, West Roxbury, MA, USA

      Qin Huang

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    1. Guifang Xu
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    Correspondence to Guifang Xu.

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    Guifang Xu, Weijie Zhang, Ying Lv, Bin Zhang, Qi Sun, Tingsheng Ling, Xiaoqi Zhang, Zhihua Zhou, Lei Wang, Qin Huang and Xiaoping Zou have no potential conflicts of interest to disclose.

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    Guifang Xu, Weijie Zhang and Ying Lv have contributed equally to this work.

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    Xu, G., Zhang, W., Lv, Y. et al. Risk factors for under-diagnosis of gastric intraepithelial neoplasia and early gastric carcinoma in endoscopic forceps biopsy in comparison with endoscopic submucosal dissection in Chinese patients. Surg Endosc 30, 2716–2722 (2016). https://doi.org/10.1007/s00464-015-4534-x

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    • DOI: https://doi.org/10.1007/s00464-015-4534-x

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