title: Endoscopic resection for undifferentiated early gastric cancer: focusing on histologic discrepancies between forceps biopsy-based and endoscopic resection specimen-based diagnosis.
abstract: BACKGROUND
  Before endoscopic resection (ER), a considerable number of undifferentiated early gastric cancer (UD-EGC) cases were initially diagnosed as atypical glands, dysplasia, or differentiated EGC (D-EGC) based on forceps biopsy specimens. As UD-EGC carries a high risk of resection margin involvement, identifying the predictive factors for UD-EGC cases with histologic discrepancy (HD) is of clinical importance.
  
  
  OBJECTIVE
  To investigate the outcomes of ER for UD-EGC and to identify the predictive factors for UD-EGC with HD.
  
  
  METHODS
  Among 2,194 EGC lesions treated by ER, 59 lesions were finally diagnosed as UD-EGC and 50 UD-EGC cases showed HD. The demographic and endoscopic characteristics were compared between D-EGC and UD-EGC with HD, and the predictive factors for the latter were investigated among cases of forceps biopsy-based diagnosis of atypical glands, dysplasia, or D-EGC.
  
  
  RESULTS
  UD-EGC showed significantly higher rate of lateral margin involvement compared to D-EGC (18.6 vs. 3.4%). Among the UD-EGC cases meeting the expanded criteria and not involving additional surgery, no local or extragastric tumor recurrence was observed during the median follow-up of 27.5 months. Multivariate analysis demonstrated that age (≤60 years), female gender, gastric body, flat or depressed type, and tumor size (>2 cm) were independent predictive factors for UD-EGC with HD among cases of forceps biopsy-based diagnosis of atypical glands, dysplasia, or D-EGC.
  
  
  CONCLUSIONS
  For lesions with predictive factors for UD-EGC with HD, a circumferential mapping biopsy before ER or wide marking during ER could be considered to avoid the potential risk of incomplete resection.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: Byung-Hoon
authors.initials: BH
authors.lastname: Min
authors.forename: Ki Joo
authors.initials: KJ
authors.lastname: Kang
authors.forename: Jun Haeng
authors.initials: JH
authors.lastname: Lee
authors.forename: Eun Ran
authors.initials: ER
authors.lastname: Kim
authors.forename: Yang Won
authors.initials: YW
authors.lastname: Min
authors.forename: Poong-Lyul
authors.initials: PL
authors.lastname: Rhee
authors.forename: Jae J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Jong Chul
authors.initials: JC
authors.lastname: Rhee
authors.forename: Kyoung-Mee
authors.initials: KM
authors.lastname: Kim
mesh_terms: D001706:Biopsy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
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