[Clinical discussion on the pathological diagnosis of high-grade intraepithelial neoplasia in gastric biopsy].
OBJECTIVE
To evaluate the value and inadequacy in clinical practice of the concept of gastric high-grade intraepithelial neoplasia (HIN).


METHODS
Forty-five cases with gastric HIN diagnosed by the esophagogastroduodenoscopy (EGD) biopsy were treated from 2003 to 2009. The clinical and histopathological data were analyzed retrospectively.


RESULTS
Radical surgeries were successfully performed on all the patients, among whom 33 underwent distal subtotal gastrectomy, 3 proximal partial gastrectomy, 7 total gastrectomy, and 2 endoscopic mucosal resection. In postoperative pathological examination, only 15 cases (33.3%) were HIN, while 14 cases (31.1%) were found to be early gastric cancers, and 16 (35.6%) were advanced cancers. Twelve(40.0%) out of 30 cancers had regional lymph nodes metastasis. When the maximum diameter of the HIN lesion was greater than 3.0 cm, or when ulcer or the features of poorly-differentiated carcinoma or signet-ring cell carcinoma were present in preoperative biopsy, the likelihood of cancer in postoperative pathological examination was higher (P<0.05), and when malignancy was confirmed, the presence of the features above was associated with lymph nodes metastasis and advanced cancer.


CONCLUSIONS
Carcinoma is identified in a large proportion of patients with gastric HIN by the EGD biopsy. Lymph nodes metastasis or advanced cancer may be detected in these cases. Cautions must be taken when the new concept of HIN is widely used for diagnosing gastric lesion. Radical resection should be considered when the maximum diameter of the HIN lesion is greater than 3.0 cm, or when ulcer, or the feature of poorly-differentiated carcinoma or signet-ring cell carcinoma are present in the EGD biopsy.
Shi
Xiang-jun
XJ
Department of General Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China. shixiangjun99999@163.com
Yang
Zhe
Z
Wang
Yu
Y
Zheng
Qi
Q
Feng
Chang-ning
CN
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology*; D055815:Young Adult