Predictors of upstage diagnosis after endoscopic resection of gastric low-grade dysplasia

Abstract

This study identified several risk factors that were significantly associated with the upstage diagnosis of gastric low-grade dysplasia: lesion size ≥ 10 mm and a variety of surface changes (erythema, nodularity, depression, and erosion). Our data indicate that if there is no evidence of these endoscopic risk factors, then regular follow-up may be considered, according to the patient's combined comorbid conditions.

Risk factors associated with histological upgrade of gastric low‐grade dysplasia on pretreatment biopsy

“…Downgrading LGD lesions was also reported after endoscopic resection, with the rate ranging from 0.8% to 4.5% . In our study the downgrade rate of the pathological diagnosis was 12.5%, which is higher than that in the published data.…”

“…The abovementioned data show that the risk of biopsy‐diagnosed LGD lesions to progress to invasive cancers is low, and most LGD lesions regress to gastritis or show no histological change. However, accumulated evidence has shown that the rates of progression from biopsy‐diagnosed LGD to HGD or gastric adenocarcinoma after endoscopic resection are higher, ranging from 12.1% to 63% . In our study, the upgrade rates of LGD to HGD or adenocarcinoma were as high as 48.9%, indicating the need for the aggressive management of biopsy‐diagnosed LGD.…”

“…Many factors have been found to be associated with a histological upgrade of LGD lesions, including lesion diameter (>1 cm, 1.5 cm, 1.8 cm or 2 cm), surface redness, depressed type, surface unevenness, presence of erosion or ulcer and nodular surface . In addition, ME‐NBI has high accuracy in distinguishing between gastritis and cancer.…”

“…Similarly, high‐grade dysplasia (HGD) or cancer may be underdiagnosed as LGD. It has been reported that 12.1–63% of biopsy‐diagnosed LGD lesions are upgraded to HGD or GC after endoscopic resection . Although some factors, including the size, color and macroscopic types of the lesions, have been suggested to be associated with histological discrepancies between pretreatment endoscopic biopsy and endoscopically resected specimens, which lesions should be removed under endoscopy or monitored by regular follow‐up remains undetermined.…”

Clinical Outcomes of Endoscopic Resection for Low-Grade Dysplasia and High-Grade Dysplasia on Gastric Pretreatment Biopsy: Korea ESD Study Group

“…Previous studies have reported that 12.1% to 63% of LGD lesions are upgraded to HGD or GC after ER. [5][6][7][8][9][10][11][12][13][14][15] In addition, gastric HGD has been shown to be GC in about 27% to 80% of cases after ER. [16][17][18] In this study, we aimed to evaluate the clinical outcomes of ER for gastric LGDs and HGDs on pretreatment FB, using the multicenter large-scale endoscopic submucosal dissection (ESD) registry database.…”