Pre- and post-ESD discrepancies in clinicopathologic criteria in early gastric cancer: the NECA–Korea ESD for Early Gastric Cancer Prospective Study (N-Keep)

Abstract

BackgroundDiscrepancies in the clinicopathologic parameters pre- and post-endoscopic submucosal dissection (ESD) sometimes necessitate additional surgical resection. The aim of this study was to assess such discrepancies in clinicopathologic parameters before and after ESD in the context of reducing the risk of failure of curative ESD.MethodsData on 712 early gastric cancer patients were prospectively collected from 12 university hospitals nationwide. The inclusion criteria were differentiated carcinoma <3 cm in size, no ulceration, submucosal invasion <500 μm, and no metastasis. Clinicopathologic factors were compared retrospectively.ResultsThe discrepancy rate was 20.1 % (148/737) and the most common cause of discrepancy was tumor size (64 cases, 8.7 %). Ulceration, undifferentiated histology, and SM2 invasion were found in 34 (4.6 %), 18 (2.4 %), and 51 cases (6.9 %), respectively. Lymphovascular invasion (LVI) was observed in 34 cases (4.6 %). Cases with lesions exceeding 3 cm in size showed more frequent submucosal invasion, an elevated gross morphology, and upper and middle locations (p < 0.05). In the cases with ulceration, depth of invasion (DOI) was deeper than in the cases without ulceration (p = 0.005). Differentiation was correlated with DOI and LVI (p = 0.021 and 0.007). DOI was correlated with tumor size, ulceration, differentiation, LVI, gross type, and location. There were statistically significant differences between mucosal cancer cases and submucosal cancer cases in tumor size, differentiation, ulceration, LVI, and location.ConclusionsThe overall discrepancy rate was 20.1 %. To reduce this rate, it is necessary to evaluate the DOI very cautiously, because it is correlated with other parameters. In particular, careful checking for SM-invasive cancer is required due to the high incidence of LVI irrespective of the depth of submucosal invasion.

The value of diagnostic endoscopic submucosal dissection for patients with clinical submucosal invasive early gastric cancer

“…Preoperative diagnoses are not always accurate. There are usually discrepancies between preoperative and postoperative tumor-size measurements, with tumor size often underestimated [13][14][15]. We limited the preoperative tumor size to less than 30 mm in diameter to satisfy the JCGA's curative resection criteria.…”

Consideration of clinicopathologic features improves patient stratification for multimodal treatment of gastric cancer

“…Lastly, due to the retrospective nature of the study, we discerned histology from pathologic evaluation of resected specimens. Thus, the possibility of changes in histologic type after resection must be considered, although discrepancies in histologic diagnosis between biopsy and pathologies of resected specimens reportedly range only from 2.4% to 4.4% [ 15 - 17 ].…”

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

“…However, endoscopic forceps biopsy specimens often do not correctly reflect the true histology . To date, there have been several studies on the rate of histopathologic discrepancies between endoscopic forceps biopsy and endoscopic resection specimens from gastric lesions, as well as regarding the factors contributing to such discrepancies . However, reports describing these types of histopathologic discrepancies and the factors predicting them have not been published for SESNs.…”

“…12 To date, there have been several studies on the rate of histopathologic discrepancies between endoscopic forceps biopsy and endoscopic resection specimens from gastric lesions, as well as regarding the factors contributing to such discrepancies. [13][14][15] However, reports describing these types of histopathologic discrepancies and the factors predicting them have not been published for SESNs. Therefore, we investigated these discrepancies and attempted to elucidate the factors contributing to them.…”