Is endoscopic forceps biopsy enough for a definitive diagnosis of gastric epithelial neoplasia?

Lee, Chang Kyun; Chung, Il‐Kwun; Lee, Suck-Ho; Kim, Sang Pil; Lee, Sae Hwan; Lee, Tae Hoon; Kim, Hongsoo; Park, Sang‐Heum; Kim, Sun‐Joo; Lee, Jihye; Cho, Hyun Deuk; Oh, Mee-Hye

doi:10.1111/j.1440-1746.2010.006367.x

Cited by 61 publications

(41 citation statements)

References 23 publications

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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%

“…This discrepancy calls into question the accuracy of forceps biopsy in differentiating adenomas from cancerous lesions. Lee et al [5] suggested that ER should be routine practice, to obtain an accurate histological diagnosis, but ER is an invasive technique that can lead to complications, including perforation or postoperative bleeding [22]. Therefore, it is desirable to predict malignancy more accurately for adenomas diagnosed by pre-treatment forceps biopsy.…”

Section: Discussionmentioning

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: 95%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

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

et al. 2012

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“…Undifferentiated histology is also a well-known risk factor for ln metastasis of egc with a pooled odds ratio of 2 (16). the rates of histological discrepancies of egc between endoscopic forceps biopsy and surgical specimens and between endoscopic forceps biopsy and er specimens were 17.5 and 25.6%, respectively (19,20). the discrepancies are important in the consideration of treatment modalities of egc.…”

Section: Discussionmentioning

confidence: 99%

Lymphovascular invasion is an important predictor of lymph node metastasis in endoscopically resected early gastric cancers

Kim

Kim²,

Park³

et al. 2011

Oncol Rep

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Abstract.With an increased incidence of early gastric cancer (egc) and advances in endoscopic technologies, endoscopic resection (er) has become an important treatment modality for egc. therefore, precise assessment of the risk of lymph node (ln) metastasis in er specimens has become essential. the widely accepted criteria for er have been mostly obtained from surgical data. this study was performed to evaluate the adequacy of these criteria and re-evaluate the predictive power of the criteria for ln metastasis. We evaluated a series of pathologic factors in er specimens from 79 gastric cancer patients treated with endoscopic mucosal resection (7) or endoscopic submucosal dissection (72) and underwent subsequent surgical resection due to the potential risk of ln metastasis. of the 79 patients, 10 patients (12.7%) exhibited regional ln metastasis. Univariate analysis revealed that the presence of lymphovascular invasion (lVI) was significantly associated with ln metastasis (26/69, 37.7 vs. 9/10, 90%, p=0.004). the number of LVI was significantly higher in the LN metastasis group (1.1±2.3 vs. 7.7±8.4, p<0.001). By multivariate analysis, the presence of lVI (odds ratio, 21.41; p=0.010) and undifferentiated histology (odds ratio, 11.15; P=0.016) were significantly correlated with ln metastasis. the presence of lVI, undifferentiated histology and the numbers of lVI were important risk factors for ln metastasis. Among these factors, the presence of lVI was the most important risk factor for ln metastasis in endoscopically resected early gastric cancer.

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“…Overall, histological discrepancy between diagnosis based on biopsy and that based on the corresponding resected specimens was seen in 44 cases (18.8 %) when the Western criteria were used, and in only 1 case (0.4 %) when the Japanese criteria were employed. Other recent studies have reported that the discrepancy rate based on the Western criteria is 2.7-44.5 % [21].…”

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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Is endoscopic forceps biopsy enough for a definitive diagnosis of gastric epithelial neoplasia?

Cited by 61 publications

References 23 publications

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

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

Lymphovascular invasion is an important predictor of lymph node metastasis in endoscopically resected early gastric cancers

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

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