Endoscopic characteristics of gastric adenomas suggesting carcinomatous transformation

Jung, Min Kyu; Jeon, Seong Woo; Park, Soo Young; Cho, Chang Min; Tak, Won Young; Kweon, Young Oh; Kim, Sung Kook; Choi, Yong Hwan; Bae, Han Ik

doi:10.1007/s00464-008-9875-2

Cited by 59 publications

(59 citation statements)

References 35 publications

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“…Recently, Jung et al [29] reported that depressed type (OR, 4.1) and com- Characterized by an increasing architectural distortion with glandular crowding and prominent cellular atypia without stromal invasion Adenocarcinoma/carcinoma Diagnosed on nuclear and structural atypia, even when invasion is absent [45] Diagnosed when evident invasive growth of neoplastic epithelium into the lamina propria of the mucosa or beyond is observed [46] LGIN: Low-grade intraepithelial neoplasia; HGIN: High-grade intraepithelial neoplasia.…”

Section: Advantage Of Endoscopic Diagnosismentioning

confidence: 99%

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Nishida¹

2011

WJGP

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Treatment strategies, whether as follow-up or "total incisional biopsy" for gastric noninvasive intraepithelial neoplasia diagnosed by examination of an endoscopic forceps biopsy specimen, are controversial due to problems associated with the diagnostic accuracy of endoscopic forceps biopsy and questions about the safety and efficacy of endoscopic treatment. Based on the histological findings of the biopsy specimen, it is difficult to differentiate between reactive or regenerative changes, inflammation and neoplastic changes, intraepithelial and invasive tumors. Therefore, gastric neoplasia diagnosed as noninvasive intraepithelial often develop into invasive carcinoma during follow-up. Recent advances in endoscopic modalities and treatment devices, such as image-enhanced endoscopy and highfrequency generators, may make endoscopic treatment, such as endoscopic submucosal dissection (ESD), a therapeutic option for gastric intraepithelial neoplasia, including low-grade neoplasms. Future studies are required to evaluate whether ESD is a valid strategy for gastric intraepithelial neoplasm with regard to safety and cost effectiveness.

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Section: Advantage Of Endoscopic Diagnosismentioning

confidence: 99%

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Nishida¹

2011

WJGP

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“…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%

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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“…[4][5][6]17 In this investigation, which was based on white light endoscopic images, we found that some specimen features, including size of 15 mm or greater, depressed appearance, central concavity, and nodular surface, were useful for predicting carcinoma as a final diagnosis in FBP adenomas, regardless of histologic grades. Previous studies have suggested high-grade dysplasia as the exclusive predictive factor carcinoma as a final diagnosis, 10,11,13 though Kim et al 12 found that depressed appearance is also predictive. One large scale study of 554 cases found that high-grade dysplasia, a biopsy number of more than three, size of no less than 2.0 cm, a morphologic type of depressed or yamada type IV, and a red or mixed-orundetermined coloration were all predictive factors of carcinoma as a final diagnosis before resection.…”

Section: Discussionmentioning

confidence: 98%

“…No previous studies have found specific endoscopic findings independently predicted re-diagnosing as carcinoma after resection, with the exception of one that identified depressed-type appearance as a predictor. [10][11][12][13] Based on our experience, we hypothesize that carcinoma as a final diagnosis may be predicted in forceps biopsy- proven (FBP) adenomas based on endoscopic features such as gross appearance, color, presence of ulcerative lesions, and surface pattern (i.e., nodularity or concavity), even though inconsistent data have appeared in the literature as predictive factors of re-diagnosing as carcinoma. [10][11][12] Herein, we investigate whether these specific endoscopic findings are statistically valuable for predicting carcinoma as a final diagnosis in FBP adenomas.…”

Section: Introductionmentioning

confidence: 99%

Four Endoscopic Predictors of Carcinoma as a Final Diagnosis after Endoscopic Resection of Forceps Biopsy-proven Gastric Adenomas

Song

Kim

Lee

et al. 2013

Korean J Helicobacter Up Gastrointest Res

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Background/Aims: Previous studies have reported that the frequency of re-diagnosing as carcinoma after endoscopic resection of gastric adenoma ranges between 6% and 47%. Therefore, specific endoscopic findings have been used to predict re-diagnosing as carcinoma after endoscopic resection of gastric adenoma at our center. We evaluated whether there is a use for these indicators for predicting carcinoma as a final diagnosis in forceps biopsy-proven adenomas. Materials and Methods:We investigated 378 tissue samples from 308 patients. Classification of specimens as adenoma and carcinoma was based on postresection specimen. Endoscopic findings were reviewed for tumor location, size, gross appearance, surface nodularity, central concavity, surface color, and presence of ulcers. These variables were analyzed and compared between the adenoma group (275 cases) and the carcinoma group (103 cases), assigned based on post-resection diagnosis. Results: The mean patient age was 61, and 227 of the patients were male. The mean lesion diameter was 14.9±8.1 mm in the adenoma group and 17.9±9.3 mm in the carcinoma group. A lesion size of 15 mm or greater, depressed appearance, surface nodularity, central concavity, and presence of high-grade dysplasia were all independently associated with re-diagnosing as carcinoma after endoscopic resection. Conclusions: Lesion size of 15 mm or greater, depressed-type appearance, central concavity, and nodular surface are feasible predictors of carcinoma as a final diagnosis in forceps biopsy-proven adenomas. Physicians need to recommend immediate endoscopic resection for forceps biopsy-proven adenomas with these four independent features so as not to miss the optimal window for treatment. (Korean J Helicobacter Up Gastrointest Res 2013;13:36-43)

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Endoscopic characteristics of gastric adenomas suggesting carcinomatous transformation

Cited by 59 publications

References 35 publications

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

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

Four Endoscopic Predictors of Carcinoma as a Final Diagnosis after Endoscopic Resection of Forceps Biopsy-proven Gastric Adenomas

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