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Discrepancy between endoscopic forceps biopsy and endoscopic resection in gastric epithelial neoplasia

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Abstract

Background

Endoscopic forceps biopsy (EFB) is a major diagnostic procedure for gastric epithelial neoplasia (GEN). However, discrepancy between the result of EFB and endoscopic resection (ER) is not uncommon. Thus, there is controversy over whether specimens obtained by EFB are optimal for diagnosis of GEN. We investigated the discrepancy between EFB and ER in the diagnosis of GEN.

Methods

A total of 1,850 GEN cases were histologically diagnosed with EFB, including 954 low-grade dysplasias (LGDs), 315 high-grade dysplasias (HGDs), and 581 carcinomas. Following diagnosis with EFB, all patients were treated with ER. We retrospectively reviewed the pathologic findings and patient characteristics and analyzed predictors for the discrepancy between the two procedures (largest diameter, number of biopsy fragments, number of biopsy fragments/largest diameter, location, macroscopic type, color, surface unevenness, and erosion).

Results

The overall discrepancy rate between EFB and ER was 31.7 % (587/1,850). Among the discordant group, 440 (23.9 %) cases showed a higher grade of disease after ER; 229 of the 954 LGDs (24.0 %) were diagnosed as HGD or carcinoma, 166 of the 315 HGDs (52.7 %) as carcinoma, and 45 of the 581 differentiated carcinomas (7.7 %) as undifferentiated carcinoma. In the LGD group with EFB, the largest diameter (≥1.8 cm; P < 0.001), surface unevenness (P = 0.014), and depressed macroscopic type (P < 0.001) were factors associated with discrepancy. In the carcinoma group with EFB, flat macroscopic type (P = 0.043) was the only significant factor. In the HGD group with EFB, there were no significant factors for discrepancy.

Conclusions

EFB can be insufficient for diagnosing GENs, and ER can be considered not only as treatment but also as a diagnostic modality in GEN. It is especially pertinent to all cases of HGD regardless of their endoscopic features and to cases of LGDs with the largest lesion diameter ≥1.8 cm, surface unevenness, or a depressed macroscopic type.

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Acknowledgments

The authors thank Dr. Sung-Koo Lee for help with the preparation of the manuscript.

Disclosures

Drs. Hyun Lim, Hwoon-Yong Jung, Young Soo Park, Hee Kyong Na, Ji Yong Ahn, Ji Young Choi, Jeong Hoon Lee, Mi-Young Kim, Kwi-Sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, and Jin-Ho Kim have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, No. 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, South Korea

    Hyun Lim, Hwoon-Yong Jung, Hee Kyong Na, Ji Yong Ahn, Ji Young Choi, Jeong Hoon Lee, Mi-Young Kim, Kwi-Sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee & Jin-Ho Kim

  2. Department of Pathology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, No. 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, South Korea

    Young Soo Park

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  1. Hyun Lim
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Correspondence to Hwoon-Yong Jung.

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Lim, H., Jung, HY., Park, Y.S. et al. Discrepancy between endoscopic forceps biopsy and endoscopic resection in gastric epithelial neoplasia. Surg Endosc 28, 1256–1262 (2014). https://doi.org/10.1007/s00464-013-3316-6

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  • DOI: https://doi.org/10.1007/s00464-013-3316-6

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