Histologic diagnosis based on forceps biopsy is not adequate for determining endoscopic treatment of gastric adenomatous lesions

Kim, Y. J.; Park, Jun Chul; Kim, J. H.; Shin, Sung Kwan; Lee, S. K.; Lee, Y. C.; Chung, Jae Yoon

doi:10.1055/s-0030-1255524

Cited by 85 publications

(84 citation statements)

References 8 publications

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“…They reported that a lesion size C2 cm, the presence of erythema, or depressed lesions were significantly associated with an upgraded histology, consistent with previous Korean studies reporting that EGC diagnosed initially with endoscopic biopsy can be underdiagnosed as LGD [2][3][4][5]. Yet, in Japan, where the term ''adenoma with low-grade atypia'' is used to describe a lesion, concerns might be raised about the endoscopic resection of adenomas with LGD.…”

supporting

confidence: 67%

Gastric Adenoma with Low-Grade Dysplasia: Two Countries, Two Outcomes

Lee

2013

Dig Dis Sci

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supporting

confidence: 67%

Gastric Adenoma with Low-Grade Dysplasia: Two Countries, Two Outcomes

Lee

2013

Dig Dis Sci

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“…The histology of pre-treatment forceps biopsy samples does not always accurately identify malignancies, while tissue from endoscopic resection (ER) tends to yield a more accurate histological diagnosis. The discrepancy rate between forceps biopsy and ER has ranged from about 20 to 45% [5][6][7]. This discrepancy calls into question the accuracy of forceps biopsy in differentiating adenomas from cancerous lesions.…”

Section: Discussionmentioning

confidence: 99%

“…In non-magnifying endoscopy, lesion size, color (red or white), macroscopic type of the lesion (depressed or others), and the presence of ulceration were examined, based on the past reports about the association between endoscopic findings and histological malignancy [6,17,20,21]. Lesion size was determined using a measuring forceps.…”

Section: Endoscopic Procedures and Diagnosismentioning

confidence: 99%

“…The malignant potential of gastric adenoma is thought to be relatively low [4]. However, we often find that the pre-treatment biopsy of gastric lesions supports a diagnosis of non-invasive low-grade neoplasia, but after ER histology is upgraded to high-grade neoplasia or invasive neoplasia [5][6][7]. One reason for this diagnostic imprecision is that small biopsy samples often do not contain enough tissue for an accurate judgment of structural atypia [8].…”

Section: Introductionmentioning

confidence: 99%

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Magnifying endoscopy with narrow-band imaging helps determine the management of gastric adenomas

et al. 2012

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Background There are no clear clinical criteria for the management of gastric lesions diagnosed as adenomas (Vienna classification category 3) by pre-treatment biopsy. In the present study, we examined the feasibility of magnifying endoscopy with narrow-band imaging (ME-NBI) in discriminating early gastric cancers (Vienna classification category 4 or 5) from adenomas in lesions diagnosed as adenomas by pre-treatment biopsy. Methods This was a single-center cross-sectional retrospective study at a tertiary referral center. One hundred thirty-seven consecutive cases of gastric lesions diagnosed as adenomas in pre-treatment forceps biopsy were examined with conventional non-magnifying endoscopy under white light, non-magnifying chromoendoscopy, and ME-NBI. We investigated the association between the final pathological diagnoses (carcinoma or adenoma) and the following factors: lesion size (mm), color (red or white), macroscopic type (depressed or others), presence of ulceration, and positive ME-NBI finding. The presence of an irregular microvascular pattern or an irregular microsurface pattern with a demarcation line between the lesion and the surrounding area was regarded as a positive ME-NBI finding. Results Lesion size was significantly larger in carcinomas than adenomas (P = 0.005). Depressed lesion (P = 0.011), red color (P \ 0.001), and positive ME-NBI finding (P \ 0.001) were significant predictive factors for carcinoma. Multivariate logistic regression confirmed that red color (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.26-7.34, P = 0.14) and a positive ME-NBI finding (OR 13.68,, P \ 0.001) were independent predictive factors for carcinomas. A positive ME-NBI finding was the strongest predictive factor. Conclusions ME-NBI is useful in planning the management of lesions diagnosed as adenomas by pre-treatment forceps biopsy.

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“…In 20-40 % of cases, diagnostic discrepancy between dysplasia evident at biopsy and GC observed in the resection specimen has been reported [34,37,44]. In most cases, the lesions were thought to be cancer at the time of initial biopsy [1,[44][45][46][47]. From a Western point of view, the final diagnosis rests on examination of the surgical or ESD specimen, because there is some possibility of cancer even if the diagnosis is LGD or HGD [21,23,36,[46][47][48].…”

Section: Discussionmentioning

confidence: 99%

Comparative study of Western and Japanese criteria for biopsy-based diagnosis of gastric epithelial neoplasia

et al. 2014

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Background In Western countries, gastric cancer (GC) is diagnosed when there is histological evidence of invasion into the lamina propria or beyond the submucosa. In Japan and some other countries, however, diagnosis of GC is based on the degree of structural and cytological abnormality of tumor glands. The aim of the present study was to compare the accuracy of the Western and Japanese criteria for diagnosis of GC. Methods The study included 233 consecutive patients with a postoperative diagnosis of submucosal invasive GC who underwent gastrectomy or endoscopic submucosal dissection. All pretreatment biopsy specimens were independently reviewed by two experts in gastrointestinal pathology employing both the Western and Japanese diagnostic criteria. Diagnostic agreement between pretreatment biopsy specimens and the corresponding resected specimens was evaluated, together with the interobserver agreement for each of the criteria. Results On the basis of the Western and Japanese criteria, the pretreatment biopsy diagnosis was noncancerous (including dysplasia) in 44 lesions and 1 lesion, respectively. Diagnostic accuracy based on biopsy was 81.1 % for the Western criteria and 99.5 % for the Japanese criteria (P \ 0.001). Interobserver agreement based on the Western and Japanese criteria was 73.8 % and 96.5 %, respectively (P \ 0.001). Invasion into the submucosa was detected by biopsy in only 25 cases. Conclusions The Japanese criteria are significantly more accurate for pretreatment biopsy diagnosis of GC. The Western criteria could lead to underdiagnosis of a lesion as high-grade dysplasia, even if submucosal invasive cancer is present.

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Histologic diagnosis based on forceps biopsy is not adequate for determining endoscopic treatment of gastric adenomatous lesions

Abstract: We should consider endoscopic resection for gastric LGD that are 2 cm or more in size and do not have whitish discoloration.

Cited by 85 publications

References 8 publications

Gastric Adenoma with Low-Grade Dysplasia: Two Countries, Two Outcomes

Gastric Adenoma with Low-Grade Dysplasia: Two Countries, Two Outcomes

Magnifying endoscopy with narrow-band imaging helps determine the management of gastric adenomas

Comparative study of Western and Japanese criteria for biopsy-based diagnosis of gastric epithelial neoplasia

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