Optimal number of endoscopic biopsies for diagnosis of early gastric cancer

Abstract

Background and study aims No recommendations are available for optimal number of endoscopic biopsies for early gastric cancer (GC), and whether detection of early GC is improved by increasing the number of biopsy is unclear. We therefore evaluated the relationship between number of biopsies and diagnostic accuracy. Materials and methods We retrospectively evaluated 858 early GCs (623 from endoscopic submucosal dissection and 235 surgical specimens), which we classified as obtained after one, two, or three or more biopsies. We assessed diagnostic accuracy by number of biopsies, and in subgroups by tumor diameter, gross type, and surface color. Results Almost half the lesions were obtained after one biopsy each, 30 % after two biopsies, and 20 % after three or more biopsies. Although diagnostic accuracy increased with biopsy number, it was significantly greater for the two-biopsy group than the one-biopsy group, (92.5 % vs. 83.9 %, P = 0.0009), but did not significantly differ between the two- and three or more-biopsy groups. This finding was seen when tumors were evaluated by size, but not by elevated type and surface color, for which more biopsies did not improve diagnostic accuracy. Multivariate analysis demonstrated that two or more biopsies was the independent significant factors for diagnostic accuracy. Conclusions Two biopsies are the optimal number required to diagnose early GC.

Endoscopic tissue sampling – Part 1: Upper gastrointestinal and hepatopancreatobiliary tracts. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…Therefore, for suspected neoplastic gastric lesions that are potentially amenable to endoscopic resection, the number of endoscopic biopsies should be limited. One large retrospective study showed that two endoscopic biopsies yielded a 92.5 % diagnostic accuracy for early gastric neoplasia [68]. Therefore, two biopsies targeted on the most suspicious parts of the lesion should be taken to document the presence of dysplasia or neoplasia.…”

Endoscopic Features of Normal and Abnormal Gastric Mucosa

“…Similar filter papers with no tissue bits are also identifiable in the next two biopsies pieces sampled were two or more compared to single tissue piece sampling from endoscopically visible lesions. Increasing the number of tissue pieces by more than two did not show any significantly different diagnostic yield [43,44].…”

“…Sydney classification has provided an easy concept in understanding the histological parameters by diagrammatic representation of the grades of mucosal changes taking place in the evolution of gastritis of the extent of chronic inflammatory cell infiltration, neutrophil infiltration, and gas-tric glands destruction and loss, extend of replacement fibrosis and goblet cell metaplasia and presence of HP [47]. In order to carry out gradings of the mucosal changes, biopsies are to be taken from different segments of the stomach and every biopsy from a particular segment is to be put into a separately labelled vial so that it can be read and interpreted separately [43,44,46]. While putting the biopsy tissue fragments, it should be made mandatory to orient and mount them on tissue paper for an optimal histological evaluation [45], which may be done with difficulty in cases of small pinch biopsies.…”

White-light endoscopy versus magnifying narrow-band imaging for diagnosis of the histological subtype of gastric cancer

“…To assess not only the primary endpoint but also the key secondary endpoint, 163 gastric cancers were required. Finally, the total sample size was set to 207 cases, considering that approximately 10% would be excluded and the false positive rate of biopsy tissue for the diagnosis of cancer would be 16.2% [25].…”