title: Endoscopic resection as a first therapy for gastric epithelial atypia: is it reasonable?
abstract: OBJECTIVE
  Gastric atypical cell (GAC), an indefinite pathologic finding, often requires repeated biopsy or other diagnostic treatments, such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or operation (OP). The aim of this study was to analyze the initial endoscopic and histologic findings of GAC and to discuss the necessity of EMR/ESD at establishing a correct diagnosis.
  
  
  METHODS
  This retrospective study enrolled 96 patients proven as GAC on index forceps biopsy. ESD (17/96, 17.7%), EMR (5/96, 5.2%), OP (20/96, 20.8%), and other treatment or follow-up (54/96, 56.3%) were performed. We analyzed the initial endoscopic and histologic characteristics of GAC lesions, predictive of neoplasm.
  
  
  RESULTS
  After diagnostic modalities, the final pathologic diagnoses were cancer (36/96, 37.6%), dysplasia (9/96, 9.4%), and non-neoplasm (51/96, 53.0%). In univariate analysis, age [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07], lesion size of 10 mm or greater (OR 3.94, 95% CI 1.61-9.61), lesion with depressed type (OR 2.50, 95% CI 1.09-5.72), and presence of H. pylori (OR 2.83, 95% CI 1.11-7.25) were risk factors for neoplasm. In multivariate analysis, lesion size of 10 mm or greater (OR 3.63, 95% CI 1.23-10.66), lesion with depressed type (OR 2.86, 95% CI 1.11-7.38) were independent risk factors for cancer.
  
  
  CONCLUSIONS
  Considering the neoplastic risk of GAC, which could be missed on biopsy, more comprehensive tissue sampling via EMR/ESD might be necessary to establish a definite diagnosis.
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
authors.forename: Chung Hoon
authors.initials: CH
authors.lastname: Yu
authors.forename: Seong Woo
authors.initials: SW
authors.lastname: Jeon
authors.forename: Sung Kook
authors.initials: SK
authors.lastname: Kim
authors.forename: Hyun Seok
authors.initials: HS
authors.lastname: Lee
authors.forename: Jun
authors.initials: J
authors.lastname: Heo
authors.forename: Yong Hwan
authors.initials: YH
authors.lastname: Kwon
authors.forename: Gyu Young
authors.initials: GY
authors.lastname: Kim
authors.forename: Sun Zoo
authors.initials: SZ
authors.lastname: Kim
authors.forename: Han Ik
authors.initials: HI
authors.lastname: Bae
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011230:Precancerous Conditions / Q000175:diagnosis / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*