Predicting pre‐ and post‐resectional histologic discrepancies in gastric low‐grade dysplasia: A comparison of white‐light and magnifying endoscopy

Abstract

MENBI can provide more accurate information than white-light endoscopy for the prediction of pre- and post-resectional histologic discrepancies in biopsy-proven gastric LGD. Endoscopic resection is strongly recommended in cases with surface erythema on conventional white-light endoscopy or positive MENBI, irrespective of the lesion size.

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

“…have shown that erythema and positive ME‐NBI findings are independent factors for a histological upgrade of LGD. In this study we found that a lesion of >20 mm in diameter, surface redness and positive ME‐NBI results were risk factors for histological upgrade, and positive ME‐NBI results had the highest odds ratio among the risk factors, which is consistent with the results of Hwang et al …”

“…The abovementioned data show that the risk of biopsy‐diagnosed LGD lesions to progress to invasive cancers is low, and most LGD lesions regress to gastritis or show no histological change. However, accumulated evidence has shown that the rates of progression from biopsy‐diagnosed LGD to HGD or gastric adenocarcinoma after endoscopic resection are higher, ranging from 12.1% to 63% . In our study, the upgrade rates of LGD to HGD or adenocarcinoma were as high as 48.9%, indicating the need for the aggressive management of biopsy‐diagnosed LGD.…”

“…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 .…”

“…Biopsy combined with ME‐NBI can improve diagnostic consistency with the pathological results of endoscopically resected specimens . Hwang et al . have shown that erythema and positive ME‐NBI findings are independent factors for a histological upgrade of LGD.…”

“…Similarly, high‐grade dysplasia (HGD) or cancer may be underdiagnosed as LGD. It has been reported that 12.1–63% of biopsy‐diagnosed LGD lesions are upgraded to HGD or GC after endoscopic resection . Although some factors, including the size, color and macroscopic types of the lesions, have been suggested to be associated with histological discrepancies between pretreatment endoscopic biopsy and endoscopically resected specimens, which lesions should be removed under endoscopy or monitored by regular follow‐up remains undetermined.…”