Low Discrepancy Between Tissue Biopsy Plus Magnifying Endoscopy With Narrow-Band Imaging and Endoscopic Resection in the Diagnosis of Gastric Epithelial Neoplasia (STROBE)

Abstract

Tissue biopsy is often not very accurate for the diagnosis of gastric epithelial neoplasia (GEN), and the results differ notably from endoscopic resection (ER) in terms of the pathological diagnosis. The aims of this study were to evaluate the diagnostic performances of biopsy, magnifying endoscopy with narrow-band imaging (ME-NBI), and biopsy plus ME-NBI for GEN.This study retrospectively analyzed 101 cases diagnosed as GEN using ER samples. The discrepancies between biopsy and ER, as well as between biopsy plus ME-NBI and ER in the diagnosis of GEN were evaluated. Factors that contributed to such discrepancies were analyzed. The sensitivity and specificity of biopsy and ME-NBI for the diagnosis of high-grade neoplasia (HGN) were determined.The discrepancy in the pathological diagnosis between biopsy and ER was 39.6% for GEN and 54.2% for HGN. The discrepancy between biopsy combined with ME-NBI and ER was 15.9% for GEN and 10.2% for HGN. Factors that undermined the diagnostic accuracy of biopsy included the lesion size (≤10 mm, odds ratio [OR] 1; 10–20 mm, OR 0.2, 95% confidence interval [CI] 0.1–0.7; >20 mm, OR 0.5, 95% CI 0.1–2.1, P = 0.03) and the number of biopsy fragments (OR 0.6, 95% CI 0.5–0.8, P = 0.001). The sensitivity and specificity for HGN were 45.8% (33.7%–58.3%) and 100% (87.5%–100%) for biopsy, and 88.1% (77.5%–94.1%) and 92.9% (81.0%–97.5%) for ME-NBI, respectively.In conclusion, biopsy-based diagnoses for GEN should be interpreted with caution. Biopsy combined with ME-NBI can contribute to the diagnosis of GEN, which improves diagnostic consistency with pathological result of ER specimens.

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

“…First, GC is a heterogeneous disease and biopsy specimens may not be considered to be representative of the entire lesion. Although increasing the number of biopsy specimens may decrease the discordance rate between biopsy and resection specimens, multiple biopsies may cause ulceration and submucosal fibrosis, which increase the risks related to endoscopic resection, such as bleeding and perforation . Second, the differential diagnosis between LGD and regenerative lesions is sometimes difficult, which may lead to the overuse of LGD diagnosis by pathologists .…”

“…In addition, ME‐NBI has high accuracy in distinguishing between gastritis and cancer. Biopsy combined with ME‐NBI can improve diagnostic consistency with the pathological results of endoscopically resected specimens . Hwang et al .…”

Endoscopic Screening in Asian Countries Is Associated With Reduced Gastric Cancer Mortality: A Meta-analysis and Systematic Review

“…Not an endoscopic screening study. Zhang et al, 2015 50 Not an endoscopic screening study. Shichijo et al, 2015 51 Not an endoscopic screening study.…”

Retrospective study

“…[18,19] A study also reported that more than 80% of HGINs progress to adenocarcinomas. [20] In our study, 54 patients (30%) showed adenocarcinomas under ESD while HGINs under CFB.…”