Missed diagnosis of early gastric cancer or high-grade intraepithelial neoplasia

Abstract

AIM: To investigate the causes of missed diagnosis of early gastric cancer (EGC) or high-grade intraepithelial neoplasia (HGIN) in Chongqing, China. METHODS: The present study summarizes 103 cases of EGC/HGIN detected by esophagogastroduodenoscopy (EGD) and pathological analysis from January 2010 to December 2011. Dimethyl silicone oil was administrated orally 15 min before the EGD procedures. The stomach was cleaned by repeated washing with saline when the gastroscope entered the stomach cavity. Suspected EGC lesions were subject to conventional biopsy sampling and pathological examinations. The correlation between lesion locations, endoscopic morphology of cancerous sites, training level of the examiners, pathological biopsies, and missed diagnosis was analyzed. RESULTS: Twenty-three cases were missed among the 103 cases (22.23%) of EGC/HGIN. The rate of missed EGC in the gastroesophageal junction (8/19, 42.1%) was significantly higher than at other sites (15/84, 17.86%) (&#x3C7;2 = 5.253, P = 0.022). In contrast, the rate of missed EGC in the lower stomach body (2/14, 14.29%) was lower than at other sites (21/89, 23.6%), but there were no significant differences (&#x3C7;2 = 0.289, P = 0.591). The rate of missed EGC in the gastric antrum (5/33, 15.15%) was lower than at other sites (18/70, 25.71%), but there were no significant differences (&#x3C7;2 = 1.443, P = 0.230). Endoscopists from less prestigious hospitals were more prone to not diagnosing EGC than those from more prestigious hospitals (&#x3C7;2 = 4.261, P = 0.039). When the number of biopsies was < 4, the rate of missed diagnosis was higher (20/23, 89.96%) than for when there were > 4 biopsies (3/23, 13.04%) (P < 0.001). In addition, there was no significant difference in the rate of missed diagnosis in patients with 1-3 biopsy specimens (&#x3C7;2 = 0.141, P = 0.932). CONCLUSION: Endoscopists should have a clear understanding of the anatomical characteristics of the esophagus/stomach, and endoscopic identification of early lesions increases with the number of biopsies

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

“…Studies have shown that misdiagnosis can be significantly reduced if ≥4 biopsy fragments are collected. 14 , 15 However, it is difficult to ensure that a large number of biopsy fragments is harvested from small lesions, and diagnoses can only be improved by increasing the accuracy of the biopsy or by using other means.…”

Optimizing early upper gastrointestinal cancer detection at endoscopy

“…11 This result is comparable to post-colonoscopy colorectal cancer rates of 2.5-7.7% in Western populations. 12 Notably, upper gastrointestinal cancer miss rates in some studies from the Far East are higher than those reported for the West, [13][14][15][16] but these series include early gastric neoplasia, whereas the Western publications report predominantly advanced cancers (Table 1).…”

“…[52][53][54] During endoscopic examinations cancerous lesions at the gastro-oesophageal junction are more commonly missed than in other regions. 15 Emphasis should be placed on careful e xamination of these areas.…”

Improving the Endoscopic Detection Rate in Patients with Early Gastric Cancer

“…A recent analysis of the endoscopic miss rate of 103 patients with EGC and high-grade dysplasia revealed that the miss rate of lesions in the esophagogastric junction area was statistically high ( p =0.022), while lesions in the upper gastric area were relatively more frequently missed than those in the lower gastric and antral areas. 11 It is well known that the blind spots of upper gastric endoscopy are the cardia, greater curvature of the upper part, posterior area of the body, pyloric area, and lesser curvature of the antrum ( Fig. 1 ).…”