Non-neoplastic pathology results after endoscopic submucosal dissection for gastric epithelial dysplasia or early gastric cancer

Yang, Min Jae; Shin, Sung Jae; Lee, Ki Seong; Lee, Kee Myung; Lim, Sun Gyo; Jinsuk, Kang; Hwang, Jae Chul; Kim, Soon Sun; Lee, Dakeun; Kim, Joosung; Lee, Gil‐Ho; Ryu, Han Seok; Yoo, Byung Moo; Lee, Kwang Jae; Kim, Young Bae; Kim, Jin Hong

doi:10.1055/s-0034-1391375

Cited by 16 publications

(9 citation statements)

References 19 publications

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“…Therefore, ER could be regarded as an improved diagnostic procedure for early gastric neoplasms [5]. With respect to the discrepancies between negative histopathological findings from forceps biopsy and ER specimens, the frequency of NPD after ER is reported to be 3.2% to 4.4% in previous studies [8,19,20], which is comparable to the 2.5% of cases in our study. They also found that the most common initial pretreatment biopsy diagnosis was LGD, which is in agreement with our data showing a higher prevalence of LGD.…”

Section: Discussionsupporting

confidence: 80%

Negative pathology after endoscopic resection of gastric epithelial neoplasms: importance of pit dysplasia

Jhi

Kim

et al. 2017

Korean J Intern Med

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Background/AimsEndoscopic resection (ER) is a well-established treatment modality for gastric epithelial neoplasm. However, there is a discrepancy between forceps biopsy and ER specimen pathology, including a negative pathologic diagnosis (NPD) after ER. It has been suggested that pit dysplasia (PD) is a subtype of gastric dysplasia, and the aim of this study was to assess the significance of PD in cases with NPD after ER for early gastric neoplasms.MethodsAfter ER, 29 NPD lesions that had an associated pretreatment forceps biopsy specimen, were correctly targeted during ER, and had no cautery artifact on the resected specimen were included in this study.ResultsSixteen lesions showed PD and 13 had no neoplastic pathology. The initial pretreatment forceps biopsy diagnoses of 29 NPD lesions were low-grade dysplasia (LGD) in 17 lesions, high-grade dysplasia (HGD) in seven lesions, and adenocarcinoma in five lesions, which after review were revised to PD in 19 lesions, LGD in four lesions, adenocarcinoma in two lesions, and no neoplastic pathology in four lesions. Overall, nine lesions (31%) were small enough to be removed by forceps biopsy, four NPD lesions (14%) were initially misinterpreted as neoplastic lesions, and 16 PD lesions (55%) were misinterpreted as NPD lesions on ER slides.ConclusionsApproximately half of the lesions initially diagnosed as LGD or HGD were subsequently classified as PD. Therefore, including PD as a subtype of gastric dysplasia could reduce the diagnostic discrepancy between initial forceps biopsy and ER specimens.

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Section: Discussionsupporting

confidence: 80%

Negative pathology after endoscopic resection of gastric epithelial neoplasms: importance of pit dysplasia

Jhi

Kim

et al. 2017

Korean J Intern Med

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“…Kim et al [34] reported that there was no residual tumor in 3.2 % (20/633) of endoscopically resected gastric dysplasia or EGC. No residual tumor after ESD can be due to complete removal of the lesion at biopsy, pathology overestimation, and incorrect localization [35]. In the present study, there were six cases of no residual tumor in the resected specimen.…”

Section: Discussionmentioning

confidence: 45%

Diagnostic group classifications of gastric neoplasms by endoscopic resection criteria before and after treatment: real-world experience

Lee

et al. 2015

Surg Endosc

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“…Although the detection of simultaneous gastric neoplasms before endoscopic resection enables the treatment of all the lesions at a single time, the cost and benefit of such treatment is uncertain. The cost and risk of repeat endoscopy with biopsy may outweigh the potential benefits of additional information about the primary lesion, which only rarely modifies the treatment strategy [19]. In addition, not only incorrect endoscopic resection but also the presence of simultaneous lesions contribute to the increase in cost.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Missed Simultaneous Gastric Lesions Based on Double-Check Analysis of the Endoscopic Image

et al. 2017

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Background/AimsThe detection of multifocal lesions is important for the successful management of gastric neoplasms. We investigated the characteristics of missed simultaneous lesions and the reason for the missed diagnoses.MethodsA total of 140 patients who underwent repeat endoscopy before endoscopic resection between June 2013 and June 2014 were retrospectively reviewed. We classified simultaneous lesions into three groups based on a review of earlier images: group 1, no images of the location of simultaneous lesions were taken; group 2, no corresponding lesion was evident in the previous images; and group 3, simultaneous lesions were visible in the earlier images but a biopsy was not performed.ResultsSimultaneous lesions were found in 12 patients (8.6%) with 13 lesions, comprising 10 dysplasia (76.9%) and three adenocarcinoma (23.1%). Regarding the reasons for missed diagnoses, seven lesions (53.8%) were classified as group 3, five (38.5%) as group 1, and the remaining lesion (7.7%) as group 2. There were no significant differences in the characteristics of the patients with and without simultaneous lesions.ConclusionsLesions disregarded or unnoticed during endoscopic examination were the main reason for missed diagnosis of simultaneous lesions. Endoscopists should consider the possibility of simultaneous lesions and attempt to meticulously evaluate the entire gastric mucosa.

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Non-neoplastic pathology results after endoscopic submucosal dissection for gastric epithelial dysplasia or early gastric cancer

Cited by 16 publications

References 19 publications

Negative pathology after endoscopic resection of gastric epithelial neoplasms: importance of pit dysplasia

Negative pathology after endoscopic resection of gastric epithelial neoplasms: importance of pit dysplasia

Diagnostic group classifications of gastric neoplasms by endoscopic resection criteria before and after treatment: real-world experience

Characteristics of Missed Simultaneous Gastric Lesions Based on Double-Check Analysis of the Endoscopic Image

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