Surgical Endoscopy

, Volume 30, Issue 1, pp 89–98 | Cite as

Endoscopic predictors for undifferentiated histology in differentiated gastric neoplasms prior to endoscopic resection

  • Ji Min Choi
  • Sang Gyun KimEmail author
  • Hyo-Joon Yang
  • Joo Hyun Lim
  • Jeongmin Choi
  • Jong Pil Im
  • Joo Sung Kim
  • Woo Ho Kim
  • Hyun Chae Jung



There is often a discrepancy between results from endoscopic forceps biopsy and resected specimen. We aimed to identify endoscopic predictors for undifferentiated histology in differentiated gastric neoplasms prior to endoscopic resection.


Medical records of the patients who underwent endoscopic submucosal dissection (ESD) for biopsy-proven differentiated gastric neoplasms at Seoul National University Hospital between July 2005 and July 2014 were retrospectively reviewed. The lesions were divided into two groups based on the final histologic result of ESD: differentiated adenocarcinoma (DA group) and undifferentiated histology (UDH group). The discordant rate, clinicopathologic characteristics, and endoscopic factors were analyzed.


A total of 1641 early gastric cancers from 1615 patients were included. Of these, 1556 (94.8 %) were diagnosed as DA and 85 (5.2 %) as UDH. The mean age was significantly lower, and number of women was higher in the UDH group than in the DA group. On multivariate analysis, age <65 years [odds ratio (OR) 1.75, 95 % confidence interval (CI) 1.10–2.80], female sex (OR 3.19, 95 % CI 2.00–5.08), endoscopic size >10 mm (OR 1.81, 95 % CI 1.12–2.92), depressed type (OR 2.85, 95 % CI 1.56–5.21), nodularity (OR 2.83, 95 % CI 1.59–5.05), and whitish discoloration (OR 19.64, 95 % CI 6.98–55.25) were independent predictors.


Female sex, age <65 years, large endoscopic size, depressed morphology, surface nodularity, and whitish discoloration were predictors for UDH. Meticulous attention should be paid to the lesions with these endoscopic predictors for determining the risk of UDH prior to endoscopic resection.


Stomach neoplasms Biopsy Endoscopy resection Undifferentiated histology 



This work was supported by a Grant from the Liver Research Institute, Seoul National University College of Medicine.


Ji Min Choi, Sang Gyun Kim, Hyo-Joon Yang, Joo Hyun Lim, Jeongmin Choi, Jong Pil Im, Joo Sung Kim, Woo Ho Kim, and Hyun Chae Jung have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Ji Min Choi
    • 1
  • Sang Gyun Kim
    • 1
    Email author
  • Hyo-Joon Yang
    • 1
  • Joo Hyun Lim
    • 2
  • Jeongmin Choi
    • 1
  • Jong Pil Im
    • 1
  • Joo Sung Kim
    • 1
  • Woo Ho Kim
    • 3
  • Hyun Chae Jung
    • 1
  1. 1.Department of Internal Medicine and Liver Research InstituteSeoul National University College of MedicineSeoulSouth Korea
  2. 2.Department of Internal Medicine, Healthcare Research InstituteSeoul National University Hospital Healthcare System Gangnam CenterSeoulSouth Korea
  3. 3.Department of PathologySeoul National University College of MedicineSeoulSouth Korea

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