Is endoscopic forceps biopsy enough for a definitive diagnosis of gastric epithelial neoplasia?
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.
Lee
Chang Kyun
CK
Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.
Chung
Il-Kwun
IK
Lee
Suck-Ho
SH
Kim
Sang Pil
SP
Lee
Sae Hwan
SH
Lee
Tae Hoon
TH
Kim
Hong-Soo
HS
Park
Sang-Heum
SH
Kim
Sun-Joo
SJ
Lee
Ji-Hye
JH
Cho
Hyun Deuk
HD
Oh
Mee-Hye
MH
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