Discrepancy between endoscopic and pathological ulcerative findings in clinical intramucosal early gastric cancer

Abstract

Background Ulcerative finding (UL) is one of the factors that define the indication and curability of endoscopic resection (ER) in early gastric cancer (EGC). Discrepancies between endoscopic UL (cUL) and pathological UL (pUL) sometimes occur in clinical practice. The aim of this study was to investigate the discrepancy rate in UL diagnosis and the risk factors associated with such discrepancies. Methods Patients with clinical intramucosal (cT1a) EGC who underwent ER or surgery between September 2002 and December 2017 were analyzed. The proportion of cUL-negative (cUL0) lesions that were identified as pUL-positive (pUL1) and that of cUL-positive (cUL1) lesions that were identified as pUL-negative (pUL0) were calculated. Logistic regression analysis was performed to estimate the associations between discrepancy in UL diagnosis and clinical variables of the lesion, such as the size, histology, location, and macroscopic type. Results In total, 5382 lesions were evaluated; 5.5% of cUL0 lesions (256/4619) were identified as pUL1, while 38.7% of cUL1 lesions (295/763) were pUL0. Multivariate analysis indicated that in cUL1 lesions, tumor location in the lower third of the stomach (odds ratio 3.11, 95% confidence interval 1.90-5.08) was identified as an independent risk factor for overestimation. Conclusions Endoscopic diagnosis of UL in cT1a EGC was overestimated in 38.7% of lesions, especially for lesions located in the lower third of the stomach. This discrepancy should be considered in the management of cT1a EGC with UL.

A Prediction Model Based on the Risk Factors Associated with Pathological Upgrading in Patients with Early-Stage Gastric Neoplasms Diagnosed by Endoscopic Forceps Biopsy

“…17,34,35 In agreement with reported data, our study demonstrated that the depressed pattern, nodular surface, surface redness, lesion size >2 cm, and location in the upper third of the stomach were risk factors in pathological upgrading. 23,36,37 EGCs located in the lower third of the stomach, especially in the antrum, might be detected easily, but for those in the upper third, detection may be difficult due to denser mucosal folds, thinner stomach, and limited endoscopic visual fields. 36 Ideally, one would incline to have a validated noninvasive biomarker to predict cancer risk.…”

“…Ulceration or ulcer scar was considered positive after excluding those caused by the biopsy. 23 Remarkable redness was defined as discoloration on the mucosal surface of the lesion compared to the surrounding mucosa, and uneven surface was defined as the presence of irregularly raised or nodular mucosa. 24 , 25 Fig.…”

A standardized pathology report for gastric cancer: 2nd edition

“…Ultimately, however, it must be confirmed by pathological examination findings of the resected specimen. Endoscopic diagnosis is difficult in the absence of a mucosal break [ 53 ], and ulcer-negative endoscopy findings with ulcer-positive pathology findings were reported in 4.6%–5.5% of cases [ 54 , 55 ].…”