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Endoscopic Resection for Undifferentiated Early Gastric Cancer: Focusing on Histologic Discrepancies Between Forceps Biopsy-Based and Endoscopic Resection Specimen-Based Diagnosis

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Abstract

Background

Before endoscopic resection (ER), a considerable number of undifferentiated early gastric cancer (UD-EGC) cases were initially diagnosed as atypical glands, dysplasia, or differentiated EGC (D-EGC) based on forceps biopsy specimens. As UD-EGC carries a high risk of resection margin involvement, identifying the predictive factors for UD-EGC cases with histologic discrepancy (HD) is of clinical importance.

Aims

To investigate the outcomes of ER for UD-EGC and to identify the predictive factors for UD-EGC with HD.

Methods

Among 2,194 EGC lesions treated by ER, 59 lesions were finally diagnosed as UD-EGC and 50 UD-EGC cases showed HD. The demographic and endoscopic characteristics were compared between D-EGC and UD-EGC with HD, and the predictive factors for the latter were investigated among cases of forceps biopsy-based diagnosis of atypical glands, dysplasia, or D-EGC.

Results

UD-EGC showed significantly higher rate of lateral margin involvement compared to D-EGC (18.6 vs. 3.4 %). Among the UD-EGC cases meeting the expanded criteria and not involving additional surgery, no local or extragastric tumor recurrence was observed during the median follow-up of 27.5 months. Multivariate analysis demonstrated that age (≤60 years), female gender, gastric body, flat or depressed type, and tumor size (>2 cm) were independent predictive factors for UD-EGC with HD among cases of forceps biopsy-based diagnosis of atypical glands, dysplasia, or D-EGC.

Conclusions

For lesions with predictive factors for UD-EGC with HD, a circumferential mapping biopsy before ER or wide marking during ER could be considered to avoid the potential risk of incomplete resection.

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Authors and Affiliations

  1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea

    Byung-Hoon Min, Jun Haeng Lee, Eun Ran Kim, Yang Won Min, Poong-Lyul Rhee, Jae J. Kim & Jong Chul Rhee

  2. Department of Medicine, Hallym University College of Medical School, Hallym University Sacred Heart Hospital, Anyang, Korea

    Ki Joo Kang

  3. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Kyoung-Mee Kim

Authors
  1. Byung-Hoon Min
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  2. Ki Joo Kang
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  3. Jun Haeng Lee
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  4. Eun Ran Kim
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  5. Yang Won Min
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  6. Poong-Lyul Rhee
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  7. Jae J. Kim
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  9. Kyoung-Mee Kim
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Corresponding author

Correspondence to Jun Haeng Lee.

Additional information

Byung-Hoon Min and Ki Joo Kang have contributed equally to this work.

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Min, BH., Kang, K.J., Lee, J.H. et al. Endoscopic Resection for Undifferentiated Early Gastric Cancer: Focusing on Histologic Discrepancies Between Forceps Biopsy-Based and Endoscopic Resection Specimen-Based Diagnosis. Dig Dis Sci 59, 2536–2543 (2014). https://doi.org/10.1007/s10620-014-3196-1

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  • DOI: https://doi.org/10.1007/s10620-014-3196-1

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