title: Clinical characterization of gastric lesions initially diagnosed as low-grade adenomas on forceps biopsy.
abstract: OBJECTIVE
  The aim of this study was to elucidate characteristics of gastric lesions that are initially diagnosed as low-grade adenomas and to establish appropriate treatment.
  
  
  METHODS
  We retrospectively reviewed 231 lesions initially diagnosed as gastric adenomas. All forceps biopsy samples were histologically diagnosed as category 3 low-grade adenomas according to the revised Vienna Classification. All patients underwent endoscopic resection with endoscopic findings and post-resection diagnoses evaluated subsequently.
  
  
  RESULTS
  Sixty-three lesions were initially diagnosed as depressed adenomas, and 168 lesions were diagnosed as protruding adenomas. The depressed lesions were significantly smaller (11.6 ± 5.0 mm) than the protruding lesions (17.0 ± 10.8 mm) (P < 0.001). Diagnoses reclassified to category 4 mucosal high-grade neoplasia (i.e. high-grade adenoma, adenocarcinoma in adenoma and adenocarcinoma) were more frequent among depressed lesions (52.4%) than among protruding lesions (31.0%) (P = 0.004). Multivariate analysis of all 231 lesions showed that lesion size larger than 20 mm (P < 0.001) and depressed appearance (including central depression) (P < 0.001) were significant independent factors suggesting cancer. For the 168 protruding lesions, lesion size larger than 20 mm (P < 0.001) and central depression (P < 0.001) were significant independent factors suggesting cancer. For the 63 depressed lesions, lesion size larger than 15 mm (P = 0.016) and a moth-eaten appearance (P = 0.017) were significant independent factors in the pre-treatment diagnosis of cancer.
  
  
  CONCLUSIONS
  Adenocarcinoma lesions were often found in depressed lesions and protruding lesions with central depression. Endoscopic resection for total biopsy is recommended, even if forceps biopsy indicates low-grade adenoma, as pre-treatment biopsy may be inadequate for an accurate histological diagnosis.
authors.affiliation: Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan. akiyoshi_81@hotmail.com
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Kasuga
authors.forename: Yorimasa
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Junko
authors.initials: J
authors.lastname: Fujisaki
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Okada
authors.forename: Masami
authors.initials: M
authors.lastname: Omae
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Ishiyama
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Hirasawa
authors.forename: Akiko
authors.initials: A
authors.lastname: Chino
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tsuchida
authors.forename: Masahiro
authors.initials: M
authors.lastname: Igarashi
authors.forename: Etsuo
authors.initials: E
authors.lastname: Hoshino
authors.forename: Noriko
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Minoru
authors.initials: M
authors.lastname: Kawaguchi
authors.forename: Rikiya
authors.initials: R
authors.lastname: Fujita
mesh_terms: D000236:Adenoma / Q000473:pathology*; D001706:Biopsy / Q000295:instrumentation*; D003937:Diagnosis, Differential; D020776:Endoscopes, Gastrointestinal; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology*