Gastric superficial neoplasia: high miss rate but slow progression

Abstract

Background and aims Gastric superficial neoplasia (GSN) is often overlooked at endoscopy because of difficulty in identifying it. The miss rate of GSN at endoscopy and the impact on clinical outcome of the missed GSN have not been fully elucidated. In this study, we investigated these issues. Methods Among 1462 endoscopically and pathologically diagnosed gastric cancers in our hospital from January 2011 to December 2014, previous records of esophagogastroduodenoscopy (EGD) were available for 198 lesions (index lesions) and were reviewed retrospectively. Among those, 157 lesions, which were diagnosed as GSN on the basis of their EGD findings at initial endoscopy, were analyzed. Progression was defined as advanced cancer in the index lesion. Results Among the 157 GSNs, 118 (75.2 %) had not been recorded in the previous EGD report but were evident upon review of endoscopic photographs for this study. Progression to advanced cancer was observed in only 13 (8.3 %) of the 157 GSNs during a mean interval of 41 months and as long as 96 months, and the rate of progression was similar in missed and not-missed lesions (8.5 % and 7.7 %, respectively). Cumulative incidence rates of progression of missed GSNs to advanced cancer were 0.8 %, 1.7 %, 4.2 %, and 7.6 % at 36, 48, 60, and 72 months after the initial EGD, respectively. Conclusions Our findings illustrate that GSNs are often missed at endoscopy but progress slowly in most cases. Even though the rate of progression to cancer is relatively low, rigorous attempts should be made to reduce the miss rate of GSNs at EGD.

Comparison of endoscopic visibility and miss rate for early gastric cancers after Helicobacter pylori eradication with white‐light imaging versus linked color imaging

“…Studies examining how commonly gastric cancer is missed at endoscopy have yielded widely varying results. [34][35][36] Shimodate et al 35 reviewed patients' earlier endoscopic records and found a miss rate for EGC of 75.2%. In our study, the miss rate was calculated by reviewing recorded videos for patients after successful eradication.…”

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“…Entscheidend für die Effektivität eines endoskopischen Screenings des OGIT sind die Schulung und das Training der Endoskopiker. In einer Metaanalyse von Menon et al lag die Gesamtrate an übersehenen Karzinomen des OGIT bei 11,3 %; und selbst in einer Studie aus Japan konnte gezeigt werden, dass 75 % neu diagnostizierter Magenkarzinome in vorangegangen Endoskopieaufnahmen erkennbar gewesen wären [9,10]. Dies verdeutlicht, dass Endoskopiker ohne entsprechendes Training trotz technischer Fortschritte die Schwachstellen in jedem endoskopischen Screeningprogramm bleiben würden.…”

Application of OCT in the Gastrointestinal Tract

“…AI has been applied to endoscopic images to help highlight or identify areas of GI cancers [103]. The miss rates for early neoplastic lesions in the GI tract are significant; one retrospective study found a miss rate of 75.2% for gastric superficial neoplasia (GSNs) [104]. Wu et al demonstrated the feasibility of deep learning in order to detect early cancers and even map the stomach to address the blind spots responsible for many of these misses during gastroscopies [105].…”