title: The risk factors for discrepancy after endoscopic submucosal dissection of gastric category 3 lesion (low grade dysplasia).
abstract: BACKGROUND
  Treatment with endoscopic submucosal dissection (ESD) for gastric category 3 lesion (low grade dysplasia, LGD) diagnosed by endoscopic forceps biopsy (EFB) is controversial.
  
  
  OBJECTIVE
  The purpose of the present study was to validate the use of ESD for gastric LGD diagnosed by EFB and to evaluate predictable factors for pathologic upgrade diagnosis to category 4 (high grade dysplasia, HGD) or 5 (early gastric cancer, EGC) lesions.
  
  
  METHODS
  Between November 2008 and October 2011, a retrospective analysis of a prospective database was conducted at a single tertiary referral center. A total of 218 ESD procedures were carried out for gastric LGD lesions identified by EFB. The under-diagnosis rate by EFB and the predictable factors for upgrade diagnosis to category 4 or 5 lesions were analyzed.
  
  
  RESULTS
  Pathologic discrepancy between EFB and surgical resection was 20.1 % (44/218). Thirty eight lesions (17.4 %) were diagnosed HGD or EGC by ESD. Gastric HGD lesions were 14 cases (6.4 %) and EGC lesions were 24 cases (23 mucosal and 1 submucosal cancer) (11.0 %). Multivariate analysis revealed that lesion diameter more than 1 cm (OR 3.496 [95 % CI 1.375-8.849]), surface redness (OR 6.493 [95 % CI 2.557-16.666]) and nodular surface (OR 2.762 [95 % CI 1.237-6.172]) were significant risk factors.
  
  
  CONCLUSIONS
  Endoscopic resection can be recommended if a LGD lesion has risk factors such as a size of 1 cm or greater, surface redness or surface nodulariy. For lesions without the risk factors, follow-up endoscopy may be recommended.
authors.affiliation: Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Korea.
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Shin
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Yong Mi
authors.initials: YM
authors.lastname: Hong
authors.forename: Jin Hyun
authors.initials: JH
authors.lastname: Park
authors.forename: Su Bum
authors.initials: SB
authors.lastname: Park
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
authors.forename: Jung Hee
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000368:Aged; D001706:Biopsy; D016009:Chi-Square Distribution; D003951:Diagnostic Errors; D004210:Dissection / Q000379:methods*; D005260:Female; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D016017:Odds Ratio; D011237:Predictive Value of Tests; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D047368:Tumor Burden