Histopathologic discrepancies between endoscopic forceps biopsy and endoscopic resection specimens in superficial esophageal squamous neoplasms

Abstract

Background and Aim Endoscopic forceps biopsy results that reflect the final pathologic results of an entire lesion are essential for making accurate diagnoses and appropriate therapeutic decisions for patients with superficial esophageal squamous neoplasms (SESNs). This study investigated the histopathologic discrepancies between endoscopic forceps biopsy and endoscopic resection specimens to elucidate the factors contributing to such discrepancies. Methods This retrospective observational study involved 77 patients (84 lesions) who underwent endoscopic resections for SESNs, between January 2005 and August 2017, at the Pusan National University Hospital. The SESNs were classified as low‐grade intraepithelial neoplasms (LGINs), high‐grade intraepithelial neoplasms (HGINs), or squamous cell carcinomas (SCCs). Following slide reviews, the histopathologic concordance between endoscopic forceps biopsy and endoscopic resection specimens was assessed, in each case. Results The histopathologic discrepancy rate between the endoscopic forceps biopsy and endoscopic resection specimens was 34.5% (29/84 lesions). Among the 29 diagnostically discordant lesions, upgrades and downgrades of the histopathologic diagnoses occurred for 27 and 2 lesions, respectively. The predominant discrepancies results in lesion upgrades from HGIN to SCC (n = 21) and from LGIN to SCC (n = 5). The two downgraded cases included one from SCC to HGIN and one from HGIN to LGIN. Multivariate analyses identified two factors that were significantly associated with the histopathologic discrepancies: upper esophageal location (odds ratio, 7.743; 95% confidence interval, 1.031–58.174; P = 0.047) and tumor area per biopsy ≥ 158.6 mm2/biopsy (odds ratio, 5.933; 95% confidence interval, 1.051–44.483; P = 0.044). Conclusion Histopathologic discrepancies were observed between endoscopic forceps biopsy and endoscopic resection specimens in patients with SESNs. Tumor location and tumor area/biopsy were both significantly associated with the discrepancies.

Histopathologic discrepancies between endoscopic forceps biopsy and endoscopic resection specimens in nonampullary duodenal epithelial tumors

“…[ 24 ] In addition, malignant cells might have spread horizontally along the basement membrane and could be misdiagnosed as LGINs if the endoscopic forceps biopsy did not contain enough tissue to include the basement membrane. [ 21 ]…”

“…[ 21 ] Conversely, a downgraded histopathologic diagnosis was defined when a lesion described as an ADC in the endoscopic biopsy was confirmed to be either an LGIN or HGIN in the endoscopic resection specimens, or when a lesion described as an HGIN in the endoscopic biopsy was reclassified as an LGIN in the endoscopic resection specimen. [ 21 ]…”

Radiofrequency Ablation for Early Superficial Flat Esophageal Squamous Cell Neoplasia: A Comprehensive Review

“…Park et al retrospectively analyzed 84 specimens of endoscopically resected superficial ESCN. Compared to the biopsy findings, 29 (34.5%) lesions showed discrepant result, of which 21 (72.4%) lesions upgraded from HGIN to ESCC [17]. Wang et al compared the pre-ESD biopsies of esophageal squamous USLs with corresponding ESD specimens and found that 29.8% of the specimens had more advanced staging than originally believed [8].…”

Pathologic interpretation of endoscopic ultrasound–guided fine needle aspiration cytology/biopsy for pancreatic lesions

“…However, any molecular test alone does not guarantee specific pathologic diagnosis, and they are more useful when used as supportive evidence rather than direct evidence of a specific disease entity. Practically, it is not uncommon to experience histopathological and immunohistochemical discrepancies between cytology/biopsy and resection specimens [27,28]. False negative results are more common on initial cytology/biopsy samples due to the heterogeneous histopathology and genomic profiles [29,30].…”