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

 

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Background and study aims: Endoscopists sometimes face paradoxical cases in which the endoscopic submucosal dissection (ESD) specimen reveals a non-neoplastic pathology result. The aims of the study were to determine the reasons for such results, and to compare the endoscopic characteristics of non-neoplastic and conventional neoplastic pathology groups after ESD.

Patients and methods: A total of 1186 gastric ESDs performed between February 2005 and December 2011 were retrospectively reviewed. The ESD specimens included 52 (4.4 %) that were confirmed as negative or indefinite for neoplasia. Patient characteristics and endoscopic and pathological data were reviewed and compared.

Results: Non-neoplastic pathology after ESD was due to complete removal of the lesion at biopsy in 45 cases (86.5 %), pathology overestimation in 5 (9.6 %), and incorrect localization of the original tumor with subsequent ESD performed at the wrong site in 2 (3.8 %). The mean length and surface area of the non-neoplastic lesions were 9.2 ± 2.6 mm and 49.6 ± 23.6 mm ², respectively. Mean sampling ratios were 3.0 ± 1.5 mm/fragment and 16.3 ± 10.0 mm²/fragment. Compared with 1134 cases confirmed as neoplastic on the final ESD specimen, non-neoplastic cases showed a significantly smaller tumor size and surface area, and lower sampling ratios in a logistic regression analysis adjusted for potential confounders (P < 0.001 for all).

Conclusions: Complete lesion removal by biopsy, pathology overestimation, and incorrect localization of the original tumor with subsequent ESD at the wrong site were the main reasons for non-neoplastic results after ESD. Small tumor size and surface area, and low sampling ratios were associated with non-neoplastic pathology results after ESD.

• References

• 1 Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 2006; 41: 929-942
  CrossrefPubMedGoogle Scholar
• 2 Tanaka M, Ono H, Hasuike N et al. Endoscopic submucosal dissection of early gastric cancer. Digestion 2008; 77 Suppl 1: 23-28
  CrossrefPubMedGoogle Scholar
• 3 Yoon WJ, Lee DH, Jung YJ et al. Histologic characteristics of gastric polyps in Korea: emphasis on discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimen. World J Gastroenterol 2006; 12: 4029-4032
  CrossrefPubMedGoogle Scholar
• 4 Sung HY, Cheung DY, Cho SH et al. Polyps in the gastrointestinal tract: discrepancy between endoscopic forceps biopsies and resected specimens. Eur J Gastroenterol Hepatol 2009; 21: 190-195
  CrossrefPubMedGoogle Scholar
• 5 Lee CK, Chung IK, Lee SH et al. Is endoscopic forceps biopsy enough for a definitive diagnosis of gastric epithelial neoplasia?. J Gastroenterol Hepatol 2010; 25: 1507-1513
  CrossrefPubMedGoogle Scholar
• 6 Takao M, Kakushima N, Takizawa K et al. Discrepancies in histologic diagnoses of early gastric cancer between biopsy and endoscopic mucosal resection specimens. Gastric Cancer 2012; 15: 91-96
  CrossrefPubMedGoogle Scholar
• 7 Kim YJ, Park JC, Kim JH et al. Histologic diagnosis based on forceps biopsy is not adequate for determining endoscopic treatment of gastric adenomatous lesions. Endoscopy 2010; 42: 620-626
  Artikel in Thieme ConnectPubMedGoogle Scholar
• 8 Won CS, Cho MY, Kim HS et al. Upgrade of lesions initially diagnosed as low-grade gastric dysplasia upon forceps biopsy following endoscopic resection. Gut Liver 2011; 5: 187-193
  CrossrefPubMedGoogle Scholar
• 9 Cho SJ, Choi IJ, Kim CG et al. Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification. Endoscopy 2011; 43: 465-471
  Artikel in Thieme ConnectPubMedGoogle Scholar
• 10 Kim ES, Jeon SW, Park SY et al. Where has the tumor gone? The characteristics of cases of negative pathologic diagnosis after endoscopic mucosal resection. . Endoscopy 2009; 41: 739-745
  Artikel in Thieme ConnectPubMedGoogle Scholar
• 11 Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002; 51: 130-131
  CrossrefPubMedGoogle Scholar
• 12 Gotoda T, Yanagisawa A, Sasako M et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000; 3: 219-225
  CrossrefPubMedGoogle Scholar
• 13 Hull MJ, Mino-Kenudson M, Nishioka NS et al. Endoscopic mucosal resection: an improved diagnostic procedure for early gastroesophageal epithelial neoplasms. Am J Surg Pathol 2006; 30: 114-118
  CrossrefPubMedGoogle Scholar
• 14 Higashimaya M, Oka S, Tanaka S et al. Outcome of endoscopic submucosal dissection for gastric neoplasm in relationship to endoscopic classification of submucosal fibrosis. Gastric Cancer 2013; 16: 404-410
  CrossrefPubMedGoogle Scholar
• 15 Jeong JY, Oh YH, Yu YH et al. Does submucosal fibrosis affect the results of endoscopic submucosal dissection of early gastric tumors?. Gastrointest Endosc 2012; 76: 59-66
  CrossrefPubMedGoogle Scholar
• 16 Ming SC, Bajtai A, Correa P et al. Gastric dysplasia. Significance and pathologic criteria. Cancer 1984; 54: 1794-1801
  CrossrefPubMedGoogle Scholar
• 17 Alfaro EE, Lauwers GY. Early gastric neoplasia: diagnosis and implications. Adv Anat Pathol 2011; 18: 268-280
  CrossrefPubMedGoogle Scholar
• 18 Lauwers GY, Riddell RH. Gastric epithelial dysplasia. Gut 1999; 45: 784-790
  CrossrefPubMedGoogle Scholar