title: Is endoscopic forceps biopsy enough for a definitive diagnosis of gastric epithelial neoplasia?
abstract: OBJECTIVE
  Endoscopic forceps biopsy (EFB) as the primary histological diagnosis of gastric epithelial neoplasia (GEN) is debated in the era of endoscopic resection (ER). Our aim was to investigate the diagnostic reliability of EFB in patients with GEN compared with ER specimens as the reference standard for the final diagnosis in a large consecutive series.
  
  
  METHODS
  This was a cross-sectional retrospective study at a tertiary-referral center. A total of 354 consecutive patients with 397 GENs underwent ER (endoscopic mucosal resection or endoscopic submucosal dissection). Discrepancy rates between the histological results from EFB and ER specimens were assessed. Discrepancies that could affect patient outcome or clinical care were considered major.
  
  
  RESULTS
  The overall histological discrepancy rate between EFB and ER specimens was 44.5% (95% confidence interval [CI], 39.7-49.5%) among the enrolled patients. The overall discrepancy rate was significantly higher in the intraepithelial neoplasia (IEN) group than in the carcinoma group (49.8% vs 25.6%, P < 0.001). The major discrepancy rate was also significantly higher in the IEN group than in the carcinoma group (36.6% vs 7.0%, P < 0.001). In subgroup analysis of the IEN group, a major histological discrepancy rate of 33.6% (70/208) for low-grade and 42.7% (44/103) for high-grade IEN was found, respectively.
  
  
  CONCLUSIONS
  Endoscopic forceps biopsy was insufficient for a definitive diagnosis and therapeutic planning in patients with GEN. ER should be considered as not only definitive treatment but also a procedure for a precise histological diagnosis for lesions initially assessed as GEN by forceps biopsy specimens.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.
authors.forename: Chang Kyun
authors.initials: CK
authors.lastname: Lee
authors.forename: Il-Kwun
authors.initials: IK
authors.lastname: Chung
authors.forename: Suck-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Sang Pil
authors.initials: SP
authors.lastname: Kim
authors.forename: Sae Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Hong-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Ji-Hye
authors.initials: JH
authors.lastname: Lee
authors.forename: Hyun Deuk
authors.initials: HD
authors.lastname: Cho
authors.forename: Mee-Hye
authors.initials: MH
authors.lastname: Oh
mesh_terms: D000368:Aged; D001706:Biopsy; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D020699:Gastroscopes; D005773:Gastroscopy; D006801:Humans; D007723:Korea; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology; D013525:Surgical Instruments