Clinical outcomes of endoscopic submucosa dissection for high-grade dysplasia from endoscopic forceps biopsy

Abstract

Background and study aimsAlthough the Vienna Classification recommends endoscopic resection for gastric high-grade dysplasia (HGD), many resected lesions are diagnosed as gastric cancer after endoscopic resection. This study aims to evaluate the clinical outcomes of gastric HGD identified by endoscopic forceps biopsy (EFB) after endoscopic submucosal dissection (ESD) and factors associated with discrepant results.Patients and methodsFrom December 2008 to July 2015, a total of 427 lesions diagnosed as initial HGD by EFB were enrolled. The rate of early gastric cancer (EGC) and factors predicting diagnosis upgrade were analyzed retrospectively.ResultsTumors ranged between 2 and 65 mm in size (median 12.59). En bloc and complete resection rates were 97.4 and 95.3%, respectively. The diagnostic discrepancy rate was 76.3%. Upgrade and downgrade rates of pathological diagnoses were 66.5 and 9.8%, respectively. Central depression (OR 4.151), nodular surface (OR 5.582), surface redness (OR 2.926), lesion location (upper third of the stomach) (OR 3.894), and tumor size ≥10 mm (OR 2.287) were significantly associated with EGC. Nodular surface (OR 2.746), submucosal fibrosis (OR 3.958), lesion location (upper third of the stomach) (OR 6.652), and tumor size ≥10 mm (OR 4.935) significantly predicted invasive submucosal cancer.ConclusionsCentral depression, nodular surface, surface redness, lesion location, large tumor size, and submucosal fibrosis were associated with EGC or submucosal cancer. Caution must be used in treating lesions with these features with ESD.

Pathologic outcomes of endoscopic submucosal dissection for gastric epithelial neoplasia

“…The reported discrepancy rates were 20% to 76% and were highly associated with pathologic grading of tissues examined by endoscopic forceps biopsy. [ 9 – 11 ]…”

Clinical Implication and Risk Factors for Malignancy of Atypical Gastric Gland during Forceps Biopsy

“…In previous studies about dysplasia, endoscopic findings with lesion size greater than 2 cm, 7 presence of ulcer, depressed morphology, 19 and hemorrhagic tendency 13 have strongly suggested high-grade adenoma or gastric cancer. 20 In revised Vienna classification category 2, lesion greater than 1 cm in diameter and surface discoloration were risk factors for carcinoma.…”

“… 3 , 7 , 8 Precise diagnosis and grading of dysplasia are important in determining the treatment strategy. Although several studies have recommended further evaluation such as big size re-biopsy for strongly suspicious lesion of malignancy, 8 , 13 , 19 endoscopic resection can be a modality for definite diagnosis and treatment of atypical gland. However, ESD may be an over-treatment for all cases of atypical gland.…”

“…It has replaced surgical treatment of early gastric cancer (EGC) in indicated cases and gastric adenoma as precancerous lesion. 13 , 14 …”

Label‐free liquid biopsy based on urine analysis using surface‐enhanced Raman spectroscopy for noninvasive gastric and breast cancer detection

“…[ 3 ] Therefore, it is significantly essential to perform early cancer screening to greatly improve patients' 5‐year survival rate. Despite technical advances recently in diagnostic techniques including magnetic resonance imaging (MRI), positron emission tomography (PET), computed tomography (CT), cytology, endoscopic forceps biopsy, and needle core biopsies, [ 4–9 ] they commonly suffer from false positive and false negative screenings because of low specificity and poor sensitivity, which significantly increases the disease burden and resource use. Moreover, these techniques are not only invasive to the patients but also unsuitable for comprehensive screening owing to high cost and complicated procedure.…”