Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic Resection as a First Therapy for Gastric Epithelial Atypia: Is It Reasonable?

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

Gastric atypical cell (GAC), an indefinite pathologic finding, often requires repeated biopsy or other diagnostic treatments, such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or operation (OP). The aim of this study was to analyze the initial endoscopic and histologic findings of GAC and to discuss the necessity of EMR/ESD at establishing a correct diagnosis.

Methods

This retrospective study enrolled 96 patients proven as GAC on index forceps biopsy. ESD (17/96, 17.7 %), EMR (5/96, 5.2 %), OP (20/96, 20.8 %), and other treatment or follow-up (54/96, 56.3 %) were performed. We analyzed the initial endoscopic and histologic characteristics of GAC lesions, predictive of neoplasm.

Results

After diagnostic modalities, the final pathologic diagnoses were cancer (36/96, 37.6 %), dysplasia (9/96, 9.4 %), and non-neoplasm (51/96, 53.0 %). In univariate analysis, age [odds ratio (OR) 1.04, 95 % confidence interval (CI) 1.01–1.07], lesion size of 10 mm or greater (OR 3.94, 95 % CI 1.61–9.61), lesion with depressed type (OR 2.50, 95 % CI 1.09–5.72), and presence of H. pylori (OR 2.83, 95 % CI 1.11–7.25) were risk factors for neoplasm. In multivariate analysis, lesion size of 10 mm or greater (OR 3.63, 95 % CI 1.23–10.66), lesion with depressed type (OR 2.86, 95 % CI 1.11–7.38) were independent risk factors for cancer.

Conclusion

Considering the neoplastic risk of GAC, which could be missed on biopsy, more comprehensive tissue sampling via EMR/ESD might be necessary to establish a definite diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut. 2002;51:130–131.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Bray F, Ren JS, Masuyer E, Ferlay J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer. 2013;132:1133–1145.

    Article  CAS  PubMed  Google Scholar 

  3. Misdraji J, Lauwers GY. Gastric epithelial dysplasia. Semin Diagn Pathol. 2002;19:20–30.

    PubMed  Google Scholar 

  4. Kim YJ, Park JC, Kim JH, et al. Histologic diagnosis based on forceps biopsy is not adequate for determining endoscopic treatment of gastric adenomatous lesions. Endoscopy. 2010;42:620–626.

    Article  CAS  PubMed  Google Scholar 

  5. Hull MJ, Mino-Kenudson M, Nishioka NS, et al. Endoscopic mucosal resection: an improved diagnostic procedure for early gastroesophageal epithelial neoplasms. Am J Surg Pathol. 2006;30:114–118.

    Article  PubMed  Google Scholar 

  6. Gotoda T. Endoscopic resection of early gastric cancer: the Japanese perspective. Curr Opin Gastroenterol. 2006;22:561–569.

    Article  PubMed  Google Scholar 

  7. Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol. 2006;41:929–942.

    Article  PubMed  Google Scholar 

  8. Kim HG, Jin SY, Jang JJ, et al. Grading system for gastric epithelial proliferative disease. Korean J Pathol. 1997;31:389–400.

    Google Scholar 

  9. Hamilton SRAL. World Health Organization classification of tumours: pathology and genetics of tumours of the digestive system. Lyon: IARC Press; 2000.

    Google Scholar 

  10. Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–123.

    Article  Google Scholar 

  11. Lee H, Yun WK, Min BH, et al. A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer. Surg Endosc. 2011;25:1985–1993.

    Article  PubMed  Google Scholar 

  12. Imagawa A, Okada H, Kawahara Y, et al. Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success. Endoscopy. 2006;38:987–990.

    Article  CAS  PubMed  Google Scholar 

  13. Yoon WJ, Lee DH, Jung YJ, et al. Histologic characteristics of gastric polyps in Korea: emphasis on discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimen. World J Gastroenterol. 2006;12:4029–4032.

    PubMed Central  PubMed  Google Scholar 

  14. Lee CK, Chung IK, Lee SH, et al. Is endoscopic forceps biopsy enough for a definitive diagnosis of gastric epithelial neoplasia? J Gastroenterol Hepatol. 2010;25:1507–1513.

    Article  PubMed  Google Scholar 

  15. Jeon SW, Jung MK, Kim SK, et al. Clinical outcomes for perforations during endoscopic submucosal dissection in patients with gastric lesions. Surg Endosc. 2010;24:911–916.

    Article  PubMed  Google Scholar 

  16. Park DI, Rhee PL, Kim JE, et al. Risk factors suggesting malignant transformation of gastric adenoma: univariate and multivariate analysis. Endoscopy. 2001;33:501–506.

    Article  CAS  PubMed  Google Scholar 

  17. Nakamura K, Sakaguchi H, Enjoji M. Depressed adenoma of the stomach. Cancer. 1988;62:2197–2202.

    Article  CAS  PubMed  Google Scholar 

  18. Jung MK, Jeon SW, Park SY, et al. Endoscopic characteristics of gastric adenomas suggesting carcinomatous transformation. Surg Endosc. 2008;22:2705–2711.

    Article  PubMed  Google Scholar 

  19. Rugge M, Leandro G, Farinati F, et al. Gastric epithelial dysplasia. How clinicopathologic background relates to management. Cancer. 1995;76:376–382.

    Article  CAS  PubMed  Google Scholar 

  20. Schistosomes, liver flukes and Helicobacter pylori. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Lyon, 7–14 June 1994. IARC monographs on the evaluation of carcinogenic risks to humans/World Health Organization, International Agency for Research on Cancer. 1994; 61:1–241.

  21. Shimoyama T, Fukuda S, Tanaka M, Nakaji S, Munakata A. Evaluation of the applicability of the gastric carcinoma risk index for intestinal type cancer in Japanese patients infected with Helicobacter pylori. Virchows Arch. 2000;436:585–587.

    Article  CAS  PubMed  Google Scholar 

  22. Parsonnet J, Vandersteen D, Goates J, Sibley RK, Pritikin J, Chang Y. Helicobacter pylori infection in intestinal- and diffuse-type gastric adenocarcinomas. J Natl Cancer Inst. 1991;83:640–643.

    Article  CAS  PubMed  Google Scholar 

  23. Eslick GD, Lim LL, Byles JE, Xia HH, Talley NJ. Association of Helicobacter pylori infection with gastric carcinoma: a meta-analysis. Am J Gastroenterol. 1999;94:2373–2379.

    Article  CAS  PubMed  Google Scholar 

  24. Kim SI, Han HS, Kim JH, et al. What is the next step for gastric atypical epithelium on histological findings of endoscopic forceps biopsy? Dig Liver. 2013;45:573–577.

    Article  Google Scholar 

  25. Lee H, Kim H, Shin SK, et al. The diagnostic role of endoscopic submucosal dissection for gastric lesions with indefinite pathology. Scand J Gastroenterol. 2012;47:1101–1107.

    Article  PubMed  Google Scholar 

  26. Yao K, Iwashita A, Tanabe H, et al. Novel zoom endoscopy technique for diagnosis of small flat gastric cancer: a prospective, blind study. Clin Gastroenterol Hepatol. 2007;5:869–878.

    Article  PubMed  Google Scholar 

  27. Ezoe Y, Muto M, Uedo N, et al. Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology. 2011;141:2017e3–2025e3.

    Article  Google Scholar 

  28. Graham DY, Schwartz JT, Cain GD, Gyorkey F. Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology. 1982;82:228–231.

    CAS  PubMed  Google Scholar 

  29. Haber MM. Gastric biopsies: increasing the yield. Clin Gastroenterol Hepatol. 2007;5:160–165.

    Article  PubMed  Google Scholar 

  30. Shiao YH, Rugge M, Correa P, Lehmann HP, Scheer WD. p53 alteration in gastric precancerous lesions. Am J Pathol. 1994;144:511–517.

    CAS  PubMed Central  PubMed  Google Scholar 

  31. Zheng H, Tsuneyama K, Cheng C, et al. An immunohistochemical study of P53 and Ki-67 in gastrointestinal adenoma and adenocarcinoma using tissue microarray. Anticancer Res. 2006;26:2353–2360.

    CAS  PubMed  Google Scholar 

  32. Zheng Y, Wang L, Zhang JP, Yang JY, Zhao ZM, Zhang XY. Expression of p53, c-erbB-2 and Ki67 in intestinal metaplasia and gastric carcinoma. World J Gastroenterol. 2010;16:339–344.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Yoo KY. Cancer control activities in the Republic of Korea. Jpn J Clin Oncol. 2008;38:327–333.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea

    Chung Hoon Yu, Seong Woo Jeon, Sung Kook Kim, Hyun Seok Lee, Jun Heo, Yong Hwan Kwon & Gyu Young Kim

  2. Department of Pathology, Kyungpook National University School of Medicine, Daegu, Republic of Korea

    Sun Zoo Kim & Han Ik Bae

  3. Gastric Cancer Center, Kyungpook National University Medical Center, 807 Hogukno, Buk-gu, Daegu, 702-210, Republic of Korea

    Seong Woo Jeon

Authors
  1. Chung Hoon Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seong Woo Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sung Kook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyun Seok Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun Heo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yong Hwan Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gyu Young Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sun Zoo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Han Ik Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seong Woo Jeon.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, C.H., Jeon, S.W., Kim, S.K. et al. Endoscopic Resection as a First Therapy for Gastric Epithelial Atypia: Is It Reasonable?. Dig Dis Sci 59, 3012–3020 (2014). https://doi.org/10.1007/s10620-014-3249-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-014-3249-5

Keywords

Search

Navigation