What is the next step for gastric atypical epithelium on histological findings of endoscopic forceps biopsy?

Kim, So-I; Han, Hye Seung; Kim, Jeong Hwan; Lee, Kyung‐Ju; Hong, Sung Noh; Lee, Sun-Young; Kim, Heung Up; Sung, Tae Sik; Zheng, Heifeng; Sung, In‐Kyung; Park, Hyung Seok; Shim, Chan Sup

doi:10.1016/j.dld.2013.01.015

Cited by 6 publications

(11 citation statements)

References 13 publications

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“…Gastritis was diagnosed in 11/80 cases (7.2%) after immediate endoscopic resection; this is similar to the false-positive rate (7.5%) observed in a previous study[8]. Although immediate endoscopic resection is considered an excellent method for IFND diagnosis[9,24], this strategy should be carefully considered as a risk for false-positive reactive change. This is because the reactive changes after medical therapy showed an unequivocal non-dysplastic epithelium.…”

Section: Discussionsupporting

confidence: 77%

“…This is because the reactive changes after medical therapy showed an unequivocal non-dysplastic epithelium. Sampling bias and intratumoral heterogeneity, ranging from reactive change and adenoma to carcinoma, may be attributable to such discrepancies[9]. However, sampling errors or insufficient biopsy volumes due to biopsy alone may not fully explain these discrepancies[25,26].…”

Section: Discussionmentioning

confidence: 99%

“…These indefinite terms are used by pathologists for cases displaying cellular architectural distortion and/or nuclear atypia that deviate from the normal but are not completely diagnostic of neoplasia. Pathologists fail to establish a definite diagnosis for reactive change, dysplasia, or carcinoma in part because of the lack of a sufficient quality and quantity of forceps biopsy specimens needed to ensure accurate diagnosis[5,7-9]. Thus, due to the possibility of dysplasia or carcinoma, follow-up evaluation according to the Vienna classification is recommended for gastric IFND cases[4,10,11].…”

Section: Introductionmentioning

confidence: 99%

“…Korea has one of the highest prevalence rates, globally, of gastric cancer[12-14]. Two previous Korean population-based studies showed that IFND lesions in the initial gastric biopsy proved to be gastric cancer in 37.6-62.5% of endoscopically resected specimens[8,9]. Although those patients were monitored for uncertain lesions endoscopically at the follow-up biopsy, difficulties in discriminating between reactive change and neoplasms even with repeated pathologic examinations remained.…”

Section: Introductionmentioning

confidence: 99%

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Treatment for gastric ‘indefinite for neoplasm/dysplasia’ lesions based on predictive factors

Kwon¹,

Kang²,

Kim³

et al. 2019

WJG

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BACKGROUNDGastric ‘indefinite for neoplasm/dysplasia’ (IFND) is a borderline lesion that is difficult to diagnose as either regenerative or neoplastic. There is a need for guidance in the identification of a subset of patients, who have an IFND lesion with a higher risk of malignant potential, to enable risk stratification and optimal management.AIMTo determine the clinical and pathologic factors for the accurate diagnosis of gastric IFND lesions.METHODSIn total, 461 gastric lesions diagnosed via biopsy as IFND lesions were retrospectively evaluated. Endoscopic resection (n = 134), surgery (n = 22), and follow-up endoscopic biopsy (n = 305) were performed to confirm the diagnosis. The time interval from initial biopsy to cancer diagnosis was measured, and diagnostic delays were categorized as > 2 wk, > 2 mo, > 6 mo, and > 1 year. The IFND lesions presenting as regenerating atypia (60%) or atypical epithelia (40%) at initial biopsy were adenocarcinomas in 22.6%, adenomas in 8.9%, and gastritis in 68.5% of the cases.RESULTSFour clinical factors [age ≥ 60 years (2.445, 95%CI: 1.305-4.580, P = 0.005), endoscopic size ≥ 10 mm (3.519, 95%CI: 1.891-6.548, P < 0.001), single lesion (5.702, 95%CI: 2.212-14.696, P < 0.001), and spontaneous bleeding (4.056, 95%CI: 1.792-9.180, P = 0.001)], and two pathologic factors [atypical epithelium (25.575, 95%CI: 11.537-56.695, P < 0.001], and repeated IFND diagnosis [6.022, 95%CI: 1.822-19.909, P = 0.003)] were independent risk factors for gastric cancer. With two or more clinical factors, the sensitivity and specificity for carcinoma were 91.3% and 54.9%, respectively. Ten undifferentiated carcinomas were initially diagnosed as IFND. In the subgroup analysis, fold change (5.594, 95%CI: 1.458-21.462, P = 0.012) predicted undifferentiated or invasive carcinoma in the submucosal layers or deeper. Diagnostic delays shorter than 1 year were not associated with worse prognoses. Extremely well-differentiated adenocarcinomas accounted for half of the repeated IFND cases and resulted in low diagnostic accuracy even on retrospective blinded review.CONCLUSIONMore than two clinical and pathologic factors each had significant cut-off values for gastric carcinoma diagnosis; in such cases, endoscopic resection should be considered.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment for gastric ‘indefinite for neoplasm/dysplasia’ lesions based on predictive factors

Kwon¹,

Kang²,

Kim³

et al. 2019

WJG

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“…Reportedly, ≥10 mm lesion size, depressed lesion, spontaneous bleeding, and surface nodularity on endoscopy were independent risk factors for gastric cancer [ 10 – 12 ]. However, other studies had shown that endoscopic lesion size, gross appearance, location, number of biopsies, and Helicobacter pylori infection were not predictive of gastric cancer [ 8 , 9 ]. In the present study, endoscopic lesion size, gross appearance, location, and number of biopsies were not associated with the final diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Novel Pathologic Factors for Risk Stratification of Gastric “Indefinite for Dysplasia” Lesions

Yim

Shin

Yoo

2020

Gastroenterology Research and Practice

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Background/Aims. “Indefinite for dysplasia” (IND) conditions of the stomach have high malignancy rates (22.6%–75.0%). Endoscopic resection is sometimes used for follow-up, but criteria for selecting this follow-up method are not established. We investigated pathologic factors to subclassify the IND of the stomach and select appropriate follow-up methods. Methods. In total, 123 IND cases with final diagnoses of cancer (29.3%), high-grade dysplasia (6.5%), low-grade dysplasia (11.4%), and nonneoplasm (52.8%) were randomly divided into test set ( n = 27 ) and validation set ( n = 96 ). By the image analysis, size, pleomorphism, hyperchromasia, irregularity of nuclei, and ratios of structural atypia area (SAA) to total IND area were measured in the test set. Using the validation set, consensus meetings were held for the evaluation of pathologic factors that predict the final diagnosis. Results. By image analysis, the only ratio of SAA to total IND area was associated with the final diagnosis ( p < 0.001 ). In the consensus meeting for validation, the nuclear factors, except loss of nuclear polarity ( p = 0.004 – 0.026 ), could not predict the final diagnosis. Conversely, most structural factors could predict the final diagnosis. In particular, SAA > 25 % was the most powerful predictive factor. We proposed criteria of risk stratification by using SAA > 25 % , loss of surface maturation (LOSM), and loss of nuclear polarity (LONP) (Malignancy rate; Category 0: SAA ≤ 25 % without LOSM and LONP; 0%, Category 1: SAA ≤ 25 % with any of LOSM or LONP; 15.2%–16.7%, Category 2: SAA > 25 % without LOSM and LONP; 44.4%–50.0%, Category 3: SAA > 25 % with any of LOSM or LONP 54.5%–55.6%). Conclusions. Structural atypia was more helpful than nuclear atypia and SAA > 25 % was the most powerful predictor for the diagnosis of INDs of the stomach. We propose shortening the follow-up period to six months for Category 1, endoscopic resection for Category 2 and 3, postresection follow-up periods of one year for Category 2, and six months for Category 3.

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Endoscopic Resection as a First Therapy for Gastric Epithelial Atypia: Is It Reasonable?

Yu¹,

Jeon²,

Kim³

et al. 2014

Dig Dis Sci

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What is the next step for gastric atypical epithelium on histological findings of endoscopic forceps biopsy?

Cited by 6 publications

References 13 publications

Treatment for gastric ‘indefinite for neoplasm/dysplasia’ lesions based on predictive factors

Treatment for gastric ‘indefinite for neoplasm/dysplasia’ lesions based on predictive factors

Novel Pathologic Factors for Risk Stratification of Gastric “Indefinite for Dysplasia” Lesions

Endoscopic Resection as a First Therapy for Gastric Epithelial Atypia: Is It Reasonable?

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