Skip to main content

Advertisement

SpringerLink
Log in

Clinicopathologic factors and outcomes of histologic discrepancy between differentiated and undifferentiated types after endoscopic resection of early gastric cancer

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Histologic discrepancies among specimens obtained by forceps biopsy and endoscopic resection (ER) between the differentiated and undifferentiated types often occur in early gastric cancer (EGC). This study aimed to evaluate the predictive clinicopathologic characteristics and clinical implications of histologic discrepancies in EGC.

Methods

From August 2005 to March 2012, 596 lesions from 579 patients underwent ER for EGC. The lesions studied were diagnosed as the differentiated histologic type from forceps biopsy specimens. The lesions were grouped according to the occurrence of histologic discrepancy between the differentiated and undifferentiated types in specimens obtained by ER as concordant (n = 570) or discordant (n = 26). The main outcome measures were en bloc resection, complete resection, and curative resection rates.

Results

The histologic discrepancy rate was 4.4 % among the studied lesions. Larger size, lesion location in the mid third of the stomach, easy friability, exudates, and submucosal invasion shown on endoscopic ultrasound were significantly related to histologic discrepancy in the univariate analysis. In the multivariate analysis, lesion location in the mid third of the stomach [odds ratio (OR) 5.34, 95 % confidence interval (CI) 1.59–19.13] and easy friability (OR 29.26, 95 % CI 2.30 to >999.9) were significant factors associated with histologic discrepancy. The complete resection and curative resection rates were significantly lower and the additional operation rates after ER were significantly higher in the discordant group.

Conclusions

The EGCs with histologic discrepancy between the differentiated and undifferentiated types changed the therapeutic outcomes of ER. Easily friable lesions located in the mid third of the stomach carry a significant risk for histologic discrepancy in undifferentiated histology when ER of EGCs is performed.

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

Abbreviations

ER:

Endoscopic resection

EGC:

Early gastric cancer

EUS:

Endoscopic ultrasound

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

References

  1. Murakami T (1971) Pathomorphological diagnosis: definition and gross classification of early gastric cancer. Gann Monogr Cancer Res 11:53–55

    Google Scholar 

  2. Ahn YO, Park BJ, Yoo KY, Kim NK, Heo DS, Lee JK, Ahn HS, Kang DH, Kim H, Lee MS et al (1991) Incidence estimation of stomach cancer among Koreans. J Korean Med Sci 6:7–14

    CAS  PubMed Central  PubMed  Google Scholar 

  3. Nakamura K, Ueyama T, Yao T, Xuan ZX, Ambe K, Adachi Y, Yakeishi Y, Matsukuma A, Enjoji M (1992) Pathology and prognosis of gastric carcinoma: findings in 10,000 patients who underwent primary gastrectomy. Cancer 70:1030–1037

    Article  CAS  PubMed  Google Scholar 

  4. Tada M, Murakami A, Karita M, Yanai H, Okita K (1993) Endoscopic resection of early gastric cancer. Endoscopy 25:445–450

    Article  CAS  PubMed  Google Scholar 

  5. Hirao M, Masuda K, Asanuma T, Naka H, Noda K, Matsuura K, Yamaguchi O, Ueda N (1988) Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline–epinephrine. Gastrointest Endosc 34:264–269

    Article  CAS  PubMed  Google Scholar 

  6. Gotoda T, Kondo H, Ono H, Saito Y, Yamaguchi H, Saito D, Yokota T (1999) A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 50:560–563

    Article  CAS  PubMed  Google Scholar 

  7. Ohkuwa M, Hosokawa K, Boku N, Ohtu A, Tajiri H, Yoshida S (2001) New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy 33:221–226

    Article  CAS  PubMed  Google Scholar 

  8. Soetikno RM, Gotoda T, Nakanishi Y, Soehendra N (2003) Endoscopic mucosal resection. Gastrointest Endosc 57:567–579

    Article  PubMed  Google Scholar 

  9. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225

    Article  PubMed  Google Scholar 

  10. Japanese Gastric Association (2011) Japanese gastric cancer treatment guidelines 2010 (version 3). Gastric Cancer 14:113–123

    Article  Google Scholar 

  11. Lee CK, Chung IK, Lee SH, Kim SP, Lee SH, Lee TH, Kim HS, Park SH, Kim SJ, Lee JH, Cho HD, Oh MH (2010) Is endoscopic forceps biopsy enough for a definitive diagnosis of gastric epithelial neoplasia? J Gastroenterol Hepatol 25:1507–1513

    Article  PubMed  Google Scholar 

  12. Takao M, Kakushima N, Takizawa K, Tanaka M, Yamaguchi Y, Matsubayashi H, Kusafuka K, Ono H (2012) Discrepancies in histologic diagnoses of early gastric cancer between biopsy and endoscopic mucosal resection specimens. Gastric Cancer 15:91–96

    Article  PubMed  Google Scholar 

  13. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma, 3rd edn. Gastric Cancer 14:101–112

    Article  Google Scholar 

  14. Kim JH, Lee YC, Kim H, Song KH, Lee SK, Cheon JH, Kim H, Hyung WJ, Noh SH, Kim CB, Chung JB (2009) Endoscopic resection for undifferentiated early gastric cancer. Gastrointest Endosc 69:e1–e9

    Article  PubMed  Google Scholar 

  15. Hamilton SR, Lauri L (eds) (2000) Pathology and genetics of tumours of the digestive system. World Health Organization Classification of Tumours. IARC, Lyon

    Google Scholar 

  16. Kim WH, Park CK, Kim YB (2005) A standardized pathology report for gastric cancer. Korean J Pathol 39:106–113

    Google Scholar 

  17. Farhat S, Chaussade S, Ponchon T, Coumaros D, Charachon A, Barrioz T, Koch S, Houcke P, Cellier C, Heresbach D, Lepilliez V, Napoleon B, Bauret P, Coron E, Le Rhun M, Bichard P, Vaillant E, Calazel A, Bensoussan E, Bellon S, Mangialavori L, Robin F, Prat F (2011) Endoscopic submucosal dissection in a European setting: a multi-institutional report of a technique in development. Endoscopy 43:664–670

    Article  CAS  PubMed  Google Scholar 

  18. Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K (2006) Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 64:877–883

    Article  PubMed  Google Scholar 

  19. Yokoi C, Gotoda T, Hamanaka H, Oda I (2006) Endoscopic submucosal dissection allows curative resection of locally recurrent early gastric cancer after prior endoscopic mucosal resection. Gastrointest Endosc 64:212–218

    Article  PubMed  Google Scholar 

  20. Yamamoto Y, Fujisaki J, Hirasawa T, Ishiyama A, Yoshimoto K, Ueki N, Chino A, Tsuchida T, Hoshino E, Hiki N, Fukunaga T, Sano T, Yamaguchi T, Takahashi H, Miyata S, Yamamoto N, Kato Y, Igarashi M (2010) Therapeutic outcomes of endoscopic submucosal dissection of undifferentiated-type intramucosal gastric cancer without ulceration and preoperatively diagnosed as 20 millimetres or less in diameter. Dig Endosc 22:112–118

    Article  PubMed  Google Scholar 

  21. Kim YJ, Park JC, Kim JH, Shin SK, Lee SK, Lee YC, Chung JB (2010) Histologic diagnosis based on forceps biopsy is not adequate for determining endoscopic treatment of gastric adenomatous lesions. Endoscopy 42:620–626

    Article  CAS  PubMed  Google Scholar 

  22. Jung MK, Jeon SW, Park SY, Cho CM, Tak WY, Kweon YO, Kim SK, Choi YH, Bae HI (2008) Endoscopic characteristics of gastric adenomas suggesting carcinomatous transformation. Surg Endosc 22:2705–2711

    Article  PubMed  Google Scholar 

  23. Park DI, Rhee PL, Kim JE, Hyun JG, Kim YH, Son HJ, Kim JJ, Paik SW, Rhee JC, Choi KW, Oh YL (2001) Risk factors suggesting malignant transformation of gastric adenoma: univariate and multivariate analysis. Endoscopy 33:501–506

    Article  CAS  PubMed  Google Scholar 

  24. Kang HY, Kim SG, Kim JS, Jung HC, Song IS (2010) Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Surg Endosc 24:509–516

    Article  PubMed  Google Scholar 

  25. Namieno T, Koito K, Higashi T, Shimamura T, Yamashita K, Sato N, Kondo Y (1998) Assessing the suitability of gastric carcinoma for limited resection: histologic differentiation of endoscopic biopsy. World J Surg 22:865–868

    Article  CAS  PubMed  Google Scholar 

  26. Tatsuta M, Iishi H, Okuda S, Oshima A, Taniguchi H (1989) Prospective evaluation of diagnostic accuracy of gastrofiberscopic biopsy in diagnosis of gastric cancer. Cancer 63:1415–1420

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  28. Ryu KW, Choi IJ, Doh YW, Kook MC, Kim CG, Park HJ, Lee JH, Lee JS, Lee JY, Kim YW, Bae JM (2007) Surgical indication for noncurative endoscopic resection in early gastric cancer. Ann Surg Oncol 14:3428–3434

    Article  PubMed  Google Scholar 

  29. Nagahama T, Yao K, Maki S, Yasaka M, Takaki Y, Matsui T, Tanabe H, Iwashita A, Ota A (2011) Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video). Gastrointest Endosc 74:1259–1267

    Article  PubMed  Google Scholar 

Download references

Disclosures

Choong Nam Shim, Hyunki Kim, Dong Wook Kim, Hyun Soo Chung, Jun Chul Park, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, and Yong Chan Lee have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea

    Choong Nam Shim, Hyun Soo Chung, Jun Chul Park, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee & Yong Chan Lee

  2. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

    Hyunki Kim

  3. Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea

    Dong Wook Kim

Authors
  1. Choong Nam Shim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyunki Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dong Wook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyun Soo Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun Chul Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyuk Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sung Kwan Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sang Kil Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yong Chan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Chan Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shim, C.N., Kim, H., Kim, D.W. et al. Clinicopathologic factors and outcomes of histologic discrepancy between differentiated and undifferentiated types after endoscopic resection of early gastric cancer. Surg Endosc 28, 2097–2105 (2014). https://doi.org/10.1007/s00464-014-3441-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3441-x

Keywords

Search

Navigation