Spectrum of final pathological diagnosis of gastric adenoma after endoscopic resection.
OBJECTIVE
To investigate how many discrepancies occur in patients before and after endoscopic treatment of referred adenoma and the reason for these results.


METHODS
We retrospectively reviewed data from 554 cases of 534 patients who were referred from primary care centres for adenoma treatment and treated for endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) at Chungnam National University Hospital, from July 2006 to June 2009. Re-endoscopy was examined in 142 cases and biopsy was performed in 108 cases prior to treatment. Three endoscopists (1, 2 and 3) performed all EMRs or ESDs and three pathologists (1, 2 and 3) diagnosed most of the cases. Transfer notes, medical records and endoscopic pictures of these cases were retrospectively reviewed and analyzed.


RESULTS
Adenocarcinoma was 72 (13.0%) cases in total 554 cases after endoscopic treatment of referred adenoma. When the grade of dysplasia was high (55.0%), biopsy number was more than three (22.7%), size was no smaller than 2.0 cm (23.2%), morphologic type was depressed (35.8%) or yamada type IV (100%), and color was red (30.9%) or mixed-or-undetermined (25.0%), it had much more malignancy rate than the others (P < 0.05). All 18 cases diagnosed as adenocarcinoma in the re-endoscopic forceps biopsy were performed by endoscopist 1. There were different malignancy rates according to the pathologist (P = 0.027).


CONCLUSIONS
High grade dysplasia is the most important factor for predicting malignancy as a final pathologic diagnosis before treating the referred gastric adenoma. This discrepancy can occur mainly through inappropriately selecting a biopsy site where cancer cells do not exist, but it also depends on the pathologist to some extent.
Gastroenterology Center, Sun Hospital, Daejeon 301-725, South Korea.
Kwan Woo
KW
Nam
Kyu Sang
KS
Song
Heon Young
HY
Lee
Byung Seok
BS
Lee
Jae Kyu
JK
Seong
Seok Hyun
SH
Kim
Hee Seok
HS
Moon
Eaum Seok
ES
Lee
Hyun Yong
HY
Jeong
D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D001706:Biopsy / Q000379:methods; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery*