title: Evaluation of routine biopsies in endoscopic screening for esophagogastric junction cancer.
abstract: OBJECTIVE
  To explore whether routine biopsies at the high incidence spot of esophagogastric junction (EGJ) cancer are justified in endoscopic screening.
  
  
  METHODS
  This was a multicenter population-based study conducted in eight high-risk areas in China. A total of 37396 participants underwent endoscopic examination. Biopsies were obtained from visible mucosal abnormalities or from normal-appearing mucosa at the high incidence spot of esophagogastric junction cancer when no abnormality was detected. Specimens showing high-grade intraepithelial neoplasia (HIN) or higher grade lesions were deemed as pathologically "positive". The ratios of positive pathologic diagnosis between participants with abnormal and normal-appearing mucosa were compared using the Pearson χ(2) test. Odds ratios and 95% confidence intervals, adjusted for potential confounders, were calculated using logistic regression.
  
  
  RESULTS
  A total of 37520 individuals participated in this study and 37396 (99.7%) participants had full information and were suitable for analysis. During endoscopic examinations, 9.11% (3405/37396) participants were found to have visible mucosal lesions. Of the participants who had normal-appearing mucosa at the EGJ, only 0.28% (94/33991) were diagnosed with HIN or higher grade lesions, whereas 6.05% (206/3405) of participants with abnormalities at the EGJ had a positive pathologic result. After controlling for other variables, visible abnormal mucosa detected under endoscopy strongly predicted a positive pathologic result (OR = 32.51, 95%CI: 23.96-44.09). The proportion of participants with "positive" pathologic diagnoses increased as the total number of endoscopic examinations performed by the doctors increased (< 5000 cases vs 5000-10000 cases vs > 10000 cases, Z = -2.7207, P = 0.0065, Cochran Armiger trend test). The same trend was found between the proportion of participants with positive pathologic diagnoses and the total number of years the doctors performed endoscopy (< 5 years vs 5-10 years vs > 10 years, Z = -10.3222, P < 0.001, Cochran Armiger trend test).
  
  
  CONCLUSIONS
  Additional routine biopsies from the high incidence spot of EGJ cancer are of limited value and are unjustified.
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Niu
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: Wen-Qiang
authors.initials: WQ
authors.lastname: Wei
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: Chang-Qing
authors.initials: CQ
authors.lastname: Hao
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: Guo-Hui
authors.initials: GH
authors.lastname: Song
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: Zhao-Lai
authors.initials: ZL
authors.lastname: Hua
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: Yong-Wei
authors.initials: YW
authors.lastname: Li
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Chang
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: Xin-Zheng
authors.initials: XZ
authors.lastname: Wang
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: De-Li
authors.initials: DL
authors.lastname: Zhao
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: Guo-Qing
authors.initials: GQ
authors.lastname: Wang
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Hsieh
authors.affiliation: Xin Niu, Wen-Qiang Wei, Guo-Qing Wang, You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000473:pathology*; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D016017:Odds Ratio; D011237:Predictive Value of Tests; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000473:pathology*; D019564:Unnecessary Procedures
keywords: Biopsy; Endoscopy; Esophagogastric junction cancer; High incidence spot; Screening