The diagnostic accuracy of conventional forceps biopsy compared to ESD

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_med-2017-0039_s_023_w2aab2b8d255b1b7b1aab1c16b1Aa"><jats:title>Objective</jats:title><jats:p>conventional forceps biopsy (CFB) is the most popular way to screen for gastric epithelial neoplasia (GEN). Our study aimed to compare the diagnostic accuracy between conventional forceps biopsy and endoscopic submucosal dissection (ESD).</jats:p></jats:sec><jats:sec id="j_med-2017-0039_s_024_w2aab2b8d255b1b7b1aab1c16b2Aa"><jats:title>Methods</jats:title><jats:p>105 patients diagnosed GEN finally undertook ESD in our hospital were enrolled. We retrospectively assessed the characteristics of pathological results of CFB and ESD.</jats:p></jats:sec><jats:sec id="j_med-2017-0039_s_025_w2aab2b8d255b1b7b1aab1c16b3Aa"><jats:title>Results</jats:title><jats:p>The overall pathologic concordance rate between the CFB and ESD specimens was 68.57%. 55 cases of CFB maintained low-grade intraepithelial neoplasia (LGIN) under ESD,18 cases (23.1%) diagnosis for high-grade intraepithelial neoplasia (HGIN), 5 cases (6.4%) diagnosis for cancer. Moreover, 10 cases of CFB maintained HGIN under ESD. Lesions with surface hyperemia (44.4% vs. 27.54%) or surface ulcer (57.14% vs.26.76%) were more likely to cancerate (P&lt;0.05).</jats:p></jats:sec><jats:sec id="j_med-2017-0039_s_026_w2aab2b8d255b1b7b1aab1c16b4Aa"><jats:title>Conclusion</jats:title><jats:p>endoscopic biopsy in the diagnosis of low-grade intraepithelial neoplasia, may exist or progression to high-grade intraepithelial neoplasia, some may have cancer, should take active treatment measures.</jats:p></jats:sec>

Histopathologic Diagnosis Discrepancies Between Preoperative Endoscopic Forceps Biopsies and Specimens Resected by Endoscopic Submucosal Dissection in Superficial Gastric Neoplasms

“…Based on the results of the present study, our recommendation is that for any visible lesions with a EFB disclosing LGD, the clinician should discuss carefully with the endoscopist and pathologist on a case-by-case basis, considering endoscopic characteristics, patients status and offering the patient endoscopic resection, preferentially by ESD if lesion size is greater than 15 mm. It provides a definitive therapeutic approach that eradicates this type of lesions, enables a reliable histopathologic assessment and therefore eliminating the risk of oncologic progression 24–26. This management algorithm is aligned with recent international guidelines proposing immediate endoscopic resection of dysplastic and neoplastic endoscopically visible lesions 27–30.…”

“…It provides a definitive therapeutic approach that eradicates this type of lesions, enables a reliable histopathologic assessment and therefore eliminating the risk of oncologic progression. [24][25][26] This management algorithm is aligned with recent international guidelines proposing immediate endoscopic resection of dysplastic and neoplastic endoscopically visible lesions. [27][28][29][30] Pimentel-Nunes et al 31 in the latest guideline of MAPS II proposed by the European Society of Gastrointestinal Endoscopy established the current standards for the management of pre-neoplastic gastric lesions; highlighting that endoscopically visible dysplasia detected by high quality endoscopic techniques (chromoendoscopy/endoscopic magnification) should be eradicated after the endoscopic diagnosis due to the high risk of oncological progression to adenocarcinoma, and that close surveillance should be reserved only for patients with histopathologic diagnosis of dysplasia without an endoscopically visible focal lesion (LGD: every 12 mo; HGD: every 6 mo).…”

“…However, there is currently no solid scientific evidence in Latin America concerning this issue. [21][22][23][24][25][26][27][28] The aim of this study was to determine the histopathologic discordance between EFB and ESD specimens for superficial gastric neoplasms, as well as to identify the predictive factors that contribute to the emergence of this histopathologic discrepancy and to evaluate the association between discordant samples of adenocarcinoma and neoplastic invasion to deeper layers.…”

Factors Predicting Pathological Upstaging of Gastric Low-Grade Dysplasia Post Endoscopic Resection: A Systematic Review and Meta-Analysis

“…The association between ulceration and LGIN upgrade diagnosis risk was assessed in six articles [5,8,10,11,15,16,18] . The pooled OR between ulceration and LGIN upgrade diagnosis was 1(95%CI).…”