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Surgical Endoscopy
Published in: Surgical Endoscopy 11/2020

01-11-2020 | Gastrectomy

Effect of histologic differences between biopsy and final resection on treatment outcomes in early gastric cancer

Authors: Yonsoo Kim, Hong Jin Yoon, Jie-Hyun Kim, Jaeyoung Chun, Young Hoon Youn, Hyojin Park, In Gyu Kwon, Seung Ho Choi, Sung Hoon Noh

Published in: Surgical Endoscopy | Issue 11/2020

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Abstract

Background and study aims

Biopsy-based histologic diagnosis is important in determining the treatment strategy for early gastric cancer (EGC). However, there are few studies on how histologic discrepancy may affect patients’ treatment outcomes. We aimed to investigate the impact of histopathologic differences between biopsy and final specimens from endoscopic resection (ER) or gastrectomy on treatment outcomes in patients with EGC. We also examined the predictive factors of histologic discrepancy.

Patients and methods

We analyzed the data of 1851 patients with EGC treated with ER or gastrectomy. We compared the histology between biopsies and final resected specimens from ER or gastrectomy. We also examined changes in treatment outcomes according to histologic differences.

Results

Histologic discrepancy was observed in 11.9% of patients in the ER group and 10.7% of those in the gastrectomy group. In patients treated with ER who showed histologic discrepancy, 80.9% showed differentiated-type EGC (D-EGC) on biopsy but undifferentiated-type-EGC (UD-EGC) after ER, of which 78.9% were non-curative resection. In patients treated with gastrectomy who showed histologic discrepancy, 39% showed UD-EGC on biopsy but showed D-EGC after gastrectomy. A total of these patients had absolute and expanded indications for ER. Moderately differentiated and poorly differentiated adenocarcinoma on biopsy were predictive factors of histologic discrepancy in UD-EGC and D-EGC on final resection, respectively.

Conclusions

About 10% of patients showed histologic discrepancy between biopsy and final resection with ER or gastrectomy. Histologic discrepancy can affect treatment outcomes, such as non-curative resection in ER or missing the opportunity for ER in gastrectomy.
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Literature
1.
Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, Brenner H, Dicker DJ, Chimed-Orchir O, Dandona R, Dandona L (2017) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol 3:524–548CrossRef
2.
Eom BW, Jung K-W, Won Y-J, Yang H, Kim Y-W (2018) Trends in gastric cancer incidence according to the clinicopathological characteristics in Korea, 1999-2014. Cancer Res Treat 50:1343CrossRef
3.
Jung K-W, Won Y-J, Oh C-M, Kong H-J, Lee DH, Lee KH (2017) Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2014. Cancer Res Treat 49:292CrossRef
4.
Choi IJ (2009) Gastric cancer screening and diagnosis. Korean J Gastroenterol 54:67–76CrossRef
5.
Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225CrossRef
6.
Association JGC (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123CrossRef
7.
Takao M, Kakushima N, Takizawa K, Tanaka M, Yamaguchi Y, Matsubayashi H, Kusafuka K, Ono H (2012) Discrepancies in histologic diagnoses of early gastric cancer between biopsy and endoscopic mucosal resection specimens. Gastric Cancer 15:91–96CrossRef
8.
Shim CN, Kim H, Kim DW, Chung HS, Park JC, Lee H, Shin SK, Lee SK, Lee YC (2014) Clinicopathologic factors and outcomes of histologic discrepancy between differentiated and undifferentiated types after endoscopic resection of early gastric cancer. Surg Endosc 28:2097–2105CrossRef
9.
Lee I-S, Park Y-S, Lee JH, Park JY, Kim H-S, Kim B-S, Yook J-H, Oh S-T, Kim B-S (2013) Pathologic discordance of differentiation between endoscopic biopsy and postoperative specimen in mucosal gastric adenocarcinomas. Ann Surg Oncol 20:4231–4237CrossRef
10.
Joo M, Kim K-M (2014) Histologic discrepancy between gastric biopsy and resection specimen in the era of endoscopic treatment for early gastric cancer. Korean J Gastroenterol 64:256–259CrossRef
11.
Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumours of the digestive system. World Health Organization, Geneva
12.
Kim WH, Park CK, Kim YB, Kim YW, Kim HG, Bae HI, Song KS, Chang HK, Chang HJ, Chae YS (2005) A standardized pathology report for gastric cancer. Korean J Pathol 39:106–113
13.
Association JGC (2011) Japanese classification of gastric carcinoma: 3rd english edition. Gastric Cancer 14:101–112CrossRef
14.
Min B-H, Kang KJ, Lee JH, Kim ER, Min YW, Rhee P-L, Kim JJ, Rhee JC, Kim K-M (2014) Endoscopic resection for undifferentiated early gastric cancer: focusing on histologic discrepancies between forceps biopsy-based and endoscopic resection specimen-based diagnosis. Dig Dis Sci 59:2536–2543CrossRef
15.
Kim JH, Kim YJ, An J, Lee JJ, Cho JH, Kim KO, Chung J-W, Kwon KA, Park DK, Kim JH (2014) Endoscopic features suggesting gastric cancer in biopsy-proven gastric adenoma with high-grade neoplasia. World J Gastroenterol 20:12233CrossRef
16.
Park JS, Hong SJ, Han JP, Kang MS, Kim HK, Kwak JJ, Ko BM, Cho JY, Lee JS, Lee MS (2013) Early-stage gastric cancers represented as dysplasia in a previous forceps biopsy: the importance of clinical management. Dig Liver Dis 45:170–175CrossRef
17.
Okada K, Fujisaki J, Yoshida T, Ishikawa H, Suganuma T, Kasuga A, Omae M, Kubota M, Ishiyama A, Hirasawa T (2012) Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy 44:122–127CrossRef
18.
Kang HY, Kim SG, Kim JS, Jung HC, Song IS (2010) Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Surg Endosc 24:509–516CrossRef
19.
Kim J-H, Lee YC, Kim H, Song KH, Lee SK, Cheon JH, Kim H, Hyung WJ, Noh SH, Kim CB (2009) Endoscopic resection for undifferentiated early gastric cancer. Gastrointest Endosc 69:e1–e9CrossRef
20.
Ninomiya Y, Yanagisawa A, Kato Y, Tomimatsu H (2000) Unrecognizable intramucosal spread of diffuse-type mucosal gastric carcinomas of less than 20 mm in size. Endoscopy 32:604–608CrossRef
21.
Katsube T, Konnno S, Hamaguchi K, Shimakawa T, Naritaka Y, Ogawa K, Aiba M (2005) The efficacy of endoscopic mucosal resection in the diagnosis and treatment of group III gastric lesions. Anticancer Res 25:3513–3516PubMed
22.
Kim J-H, Kim YH, Jung DH, Jeon HH, Lee YC, Lee H, Lee SK, Park JC, Shin SK, Youn YH (2014) Follow-up outcomes of endoscopic resection for early gastric cancer with undifferentiated histology. Surg Endosc 28:2627–2633CrossRef
23.
Hahn KY, Park CH, Lee YK, Chung H, Park JC, Shin SK, Lee YC, Kim H-I, Cheong J-H, Hyung WJ (2018) Comparative study between endoscopic submucosal dissection and surgery in patients with early gastric cancer. Surg Endosc 32:73–86CrossRef
24.
Yao K, Anagnostopoulos G, Ragunath K (2009) Magnifying endoscopy for diagnosing and delineating early gastric cancer. Endoscopy 41:462–467CrossRef
25.
Bok GH, Jeon SR, Cho JY, Cho J-H, Lee WC, Jin SY, Choi IH, Kim HG, Lee TH, Park EJ (2013) The accuracy of probe-based confocal endomicroscopy versus conventional endoscopic biopsies for the diagnosis of superficial gastric neoplasia (with videos). Gastrointest Endosc 77:899–908CrossRef
26.
Lee JH, Kim J-H, Rhee K, Huh CW, Lee YC, Yoon SO, Youn YH, Park H, Lee SI (2013) Undifferentiated early gastric cancer diagnosed as differentiated histology based on forceps biopsy. Pathol Res Pract 209:314–318CrossRef
Metadata
Title
Effect of histologic differences between biopsy and final resection on treatment outcomes in early gastric cancer
Authors
Yonsoo Kim
Hong Jin Yoon
Jie-Hyun Kim
Jaeyoung Chun
Young Hoon Youn
Hyojin Park
In Gyu Kwon
Seung Ho Choi
Sung Hoon Noh
Publication date
01-11-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07301-z

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