Analysis of endoscopic features for histologic discrepancies between biopsy and endoscopic submucosal dissection in gastric neoplasms: 10-year results

Histopathologic discrepancy between endoscopic forceps biopsy and final pathology and the role of transrectal ultrasound-guided core needle biopsy

“…(I) downgraded: when the diagnoses of the subsequent final results show a histology of less malignant potential, e.g., from high-grade dysplasia to lowgrade dysplasia, from low-grade dysplasia to nonneoplasia, or from adenocarcinoma to adenoma; (II) concordant: when the diagnoses obtained through EFB and final results are the same; (III) upgraded: when the diagnoses of the final specimen showed a histology of more malignant potential, e.g., from low-grade dysplasia to highgrade dysplasia, from high-grade dysplasia to adenocarcinoma, or from low-grade dysplasia to adenocarcinoma. Regarding the stomach, a discrepancy of 33.9-49% is reported from the study comparing the EFB outcome and the final result obtained after endoscopic resection (3)(4)(5)(6). On the other hand, the confirmation rate of invasive cancer from preoperative EFB of rectal lesions is reported as 58.7-67.3% (7,8), which is slightly higher than the result obtained from the study on the stomach.…”

“…The risk factors commonly associated with upgrade discrepancy include lesion size, depressed morphology, ulceration, and whitish discoloration (6,9,10). These risk factors were confirmed from stomach lesions; in comparison, there are insufficient studies on the association with discrepancy in colorectal lesions.…”

“…Morphology of the lesion is reported as a risk factor for discrepancy in various studies. Depressed lesions were reported as an independent risk factor for upgrade discrepancy in several studies (6,13,14). Therefore, endoscopists need to pay careful attention in cases with large lesions, surface ulceration, and depressed morphology.…”

Risk factor-based optimal endoscopic surveillance intervals after endoscopic submucosal dissection for gastric adenoma

“…The diagnosis of gastric adenoma is made after biopsy during the endoscopic evaluation. However, due to the discrepancy between the pathologic results of the endoscopic forceps biopsy and the resected specimen, the final diagnosis can be upgraded to cancer 4 – 6 . In particular, adenoma with high-grade dysplasia showed higher rates of discrepancy after upgradation 6 .…”

“…However, due to the discrepancy between the pathologic results of the endoscopic forceps biopsy and the resected specimen, the final diagnosis can be upgraded to cancer 4 – 6 . In particular, adenoma with high-grade dysplasia showed higher rates of discrepancy after upgradation 6 . Therefore, when gastric adenoma is detected through endoscopic examination, it needs to be removed, and the complete histopathologic work-up should be performed 7 .…”