title: Risk factors for under-diagnosis of gastric intraepithelial neoplasia and early gastric carcinoma in endoscopic forceps biopsy in comparison with endoscopic submucosal dissection in Chinese patients.
abstract: Differences in pathologic diagnosis between endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) for gastric intraepithelial neoplasia (GIN) and early gastric carcinoma (EGC) in Chinese patients remain unknown. The aim of the study was to investigate risk factors for under-diagnosed pathology in initial EFB, compared to final ESD. We reviewed endoscopic and histopathologic findings for tumor location, size, macroscopic pattern, nodularity, erythema, erosion, GIN (low and high grade), and EGC diagnosed with the WHO criteria. Differences in those features between EFB and ESD were compared and risk factors for under-diagnosis by EFB were analyzed. Although concordant in most (74.9 %) cases between EFBs and ESDs, pathological diagnoses in 57 (25.1 %) cases were upgraded in ESDs. Compared to the concordant group, the lesion size ≥2 cm, and depressed and excavated patterns were significantly more frequent in the upgraded group. Further multivariate regression analysis demonstrated the depressed pattern and lesion size ≥2 cm as independent risk factors for upgraded pathology with the odds ratio of 5.778 (95 % confidence interval 2.893-11.542) and 2.535 (95 % confidence interval 1.257-5.111), respectively. Lesion size ≥2.0 cm and the depressed pattern at initial EFB were independent risk factors for pathologic upgrade to advanced diseases in ESD. Therefore, these endoscopic characteristics should be considered together with the initial EFB diagnosis to guide the optimal clinical management of patients with GIN and EGC.
authors.affiliation: Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China. 13852293376@163.com.
authors.forename: Guifang
authors.initials: G
authors.lastname: Xu
authors.affiliation: Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
authors.forename: Weijie
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Lv
authors.affiliation: Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Tingsheng
authors.initials: T
authors.lastname: Ling
authors.affiliation: Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Xiaoqi
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Pathology, 101 Hospital of PLA, Wuxi, China.
authors.forename: Zhihua
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Pathology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.|Department of Pathology and Laboratory Medicine, VA Boston Healthcare System and Harvard Medical School, 1400 VFW Parkway, West Roxbury, MA, USA.
authors.forename: Qin
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Zou
mesh_terms: D001706:Biopsy / Q000295:instrumentation / Q000379:methods*; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000473:pathology; D002681:China; D003951:Diagnostic Errors; D055088:Early Detection of Cancer; D000069916:Endoscopic Mucosal Resection; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology; D013525:Surgical Instruments
keywords: Chinese; Early gastric carcinoma; Endoscopic forceps biopsies; Endoscopic submucosal dissection; Gastric epithelial neoplasia