Clinical Features of False-Negative Early Gastric Cancers: A Retrospective Study of Endoscopic Submucosal Dissection Cases

Abstract

Background. We frequently encounter early gastric cancer (EGC) that could not be detected in the previous esophagogastroduodenoscopy even if the procedure was annually performed. However, little evidence exists regarding the characteristics of false-negative EGCs. Our aim was to reveal the clinical features of false-negative EGCs. Methods. We retrospectively reviewed cases of endoscopic submucosal dissection (ESD) for EGCs in Fukuchiyama City Hospital between January 2013 and May 2019. False-negative EGCs were defined as EGCs within 3 years of negative endoscopy. We evaluated the clinical characteristics of false-negative and initially detected EGCs and the difference in the detected and last missed endoscopy in false-negative EGCs. The miss rates of false-negative EGCs were compared between trainees (nonboard-certified endoscopists) and experienced endoscopists (board-certified endoscopists); thereafter, the characteristics of false-negative EGCs missed by trainees were investigated. Results. Of 219 cases, 119 were classified as false-negative EGCs. False-negative EGCs were characterized as smaller lesions, which presented with normal color or gastritis-like appearance, and were diagnosed after ESD and H. pylori eradication ( P < 0.01 ). The rate of trainees in the last missed endoscopy was significantly higher than that in the detected endoscopy. The miss rate of false-negative EGC by trainees was higher than that of experienced endoscopists but not significantly different (0.70% vs. 0.57%, P = 0.08 ). The false-negative EGCs missed by trainees were characterized as reddish or well-differentiated lesions, which were located in the lower or lesser curvature of the stomach ( P < 0.05 ). Conclusion. The characteristics of false-negative EGCs were similar to those of H. pylori-eradicated EGC. Procedures with shortened examination time and those performed by trainees were risk factors of missing false-negative EGCs. Trainees should pay attention to reddish or well-differentiated EGCs located in the lower or lesser curvature of the stomach.

Variation in the rate of detection of minute and small early gastric cancers at diagnostic endoscopy may reflect the performance of individual endoscopists

“…Reported detection and missed rates of gastric neoplasm for trainees are not significantly different than those for experienced endoscopists,22–25 even though endoscopic training and education were essential ways to increase the GC detection 26 27. Our study had similar findings: the observed GC detection rates in routine EGDs bore no relation to whether the endoscopists were trainees or experienced, board-certified endoscopists.…”

“…Reported detection and missed rates of gastric neoplasm for trainees are not significantly different than those for experienced endoscopists, [22][23][24][25] even though endoscopic training and education were essential ways to increase the GC detection. 26 27 Our study had similar findings: the observed GC detection rates in routine Since the endoscopists with the highest and lowest detection rates (2.87% and 0.09%) were so far removed from the detection rates of the other endoscopists, we excluded those data as outliers from this comparative analysis.…”

Helicobacter pylori Eradication Does Not Adversely Affect the Clinical Course of Gastric Cancer: A Multicenter Study on Screening Endoscopic Examination in Japan

“…Studies have shown that HP eradication conceals the findings of early cancer lesions, which may lead to a delayed cancer diagnosis [7][8][9][10]24]. Moreover, two previous studies demonstrated that this concern could be a real issue by showing that post-eradicated GC showed a higher proportion of submucosal invasion than cases of HP-positive GC [11,12].…”

“…Still, HP eradication was not significantly associated with GCs with deep tumor invasion, even after adjusting for such cancer lesion-related factors, suggesting that the effect of HP eradication does not predispose one to develop GC with deep tumor invasion. As studies have demonstrated, HP eradication may make it difficult to diagnose early-stage GC by obscuring the characteristic lesions [7][8][9][10]24]. At the same time, other studies demonstrated that HP eradication decreased the proliferation of GC [7,25], suggesting that the growth of neoplastic lesions was decelerated in HP-eradicated cases [21,[26][27][28].…”

Advances in the Aetiology & Endoscopic Detection and Management of Early Gastric Cancer

“…Optimal mucosal visualisation should be obtained through a combination of air insufflation, aspiration and the use of mucosal cleansing techniques with mucolytic and defoaming agents (e.g., N -acetylcysteine and simethicone) [ 157 ], see Figure 8 , Figure 9 , Figure 10 , Figure 11 , Figure 12 , Figure 13 , Figure 14 . Despite progress made to date, premalignant lesions and early gastric cancer are still being missed [ 191 , 192 ]. A meta-analysis of 22 studies estimated a rate of missed gastric cancer at endoscopy of 9.4% [ 193 ].…”