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Endoscopic resection for gastric epithelial neoplasia: How to solve pathological discrepancy and achieve curative resection?
Author(s) -
Zhu Ling Yin,
Dai Jun,
Zhao Yun Jia,
Xue Han Bin,
Ge Zhi Zheng,
Li Xiao Bo
Publication year - 2013
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12032
Subject(s) - medicine , intraepithelial neoplasia , malignancy , pathological , forceps , biopsy , resection , gastroenterology , cancer , surgery , prostate
Objective Endoscopic resection ( ER ) was introduced to China from J apan, while most pathologists are influenced by W estern criteria. Japanese and Western pathologists have debated for decades how best to distinguish between gastric intraepithelial neoplasia ( GIEN ) and early gastric cancer ( EGC ). In this study we aimed to find out how to solve this pathological discrepancy and improve the curative resection of lesions based on our experiences. Methods In total, 143 patients with GIEN or EGC were treated by ER in our hospital from A pril 2008 to A pril 2012. The risk factors related to the degree of malignancy of the lesions and the non‐curability of ER were analyzed. Pathological discrepancy between forceps biopsies and ER specimens was also compared.Results According to the histological types of the ER specimens, there were 67 patients with low‐grade intraepithelial neoplasia ( LGIN ), 35 with high‐grade intraepithelial neoplasia ( HGIN ) and 41 with EGC . The ER histological type was significantly correlated with gender, ER method, macroscopic type, tumor size, ulcer and histological type of the forceps biopsy ( P < 0.05). The discrepancy between forceps biopsy and ER specimens was 41.3% (59/143). Furthermore, the depth of tumor invasion and ER histological type were associated with the curative resection of HGIN and EGC ( P < 0.05). Conclusions The pathological discrepancy shows that patients with HGIN in forceps biopsy should be considered candidates for ER . The risk factors of lesion malignancy and ER curability indicate the great importance of pretreatment evaluation for ER .