title: Predicting pre- and post-resectional histologic discrepancies in gastric low-grade dysplasia: A comparison of white-light and magnifying endoscopy.
abstract: OBJECTIVE
  The aim of this study was to evaluate the validity of the parameters of conventional white-light endoscopy and magnifying endoscopy with narrow-band imaging (MENBI) for the prediction of discrepancies between pre- and post-resectional histology in cases of gastric adenoma with low-grade dysplasia (LGD) that were diagnosed based on endoscopically biopsied specimens.
  
  
  METHODS
  The medical records of 266 lesions with gastric LGD that were diagnosed by endoscopic forceps biopsies were retrospectively reviewed. The Vienna classification was used for histologic diagnosis. These patients all underwent MENBI examinations followed by analyses of the incidence of histologic discrepancies and histologic heterogeneity. The relationship between white-light endoscopic/MENBI parameters and the presence of histologic discrepancies was also analyzed.
  
  
  RESULTS
  Discrepancies between the pre- and post-resectional histologies were found in 74 cases (27.9%). Among those cases, the histology was upgraded in 71 cases, whereas the histology was downgraded in three cases. The presence of erythema and positive MENBI findings were independent factors for the prediction of upgraded histologic discrepancies (P-values = 0.008, < 0.001, respectively). A positive MENBI finding yielded the highest predictive value, with a multivariate adjusted odds ratio of 42.46. Histologic heterogeneity in post-resectional specimens was found in 40.8% of cases with upgraded histologic discrepancies.
  
  
  CONCLUSIONS
  MENBI can provide more accurate information than white-light endoscopy for the prediction of pre- and post-resectional histologic discrepancies in biopsy-proven gastric LGD. Endoscopic resection is strongly recommended in cases with surface erythema on conventional white-light endoscopy or positive MENBI, irrespective of the lesion size.
authors.affiliation: Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Bae
authors.affiliation: Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Mi Seon
authors.initials: MS
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Sam Ryong
authors.initials: SR
authors.lastname: Jee
authors.affiliation: Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Sang Heon
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Min Sung
authors.initials: MS
authors.lastname: An
authors.affiliation: Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Kwang Hee
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Ki Beom
authors.initials: KB
authors.lastname: Bae
authors.affiliation: Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Bomi
authors.initials: B
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Sang Young
authors.initials: SY
authors.lastname: Seol
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000473:pathology*; D000368:Aged; D001706:Biopsy / Q000295:instrumentation / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology*; D013525:Surgical Instruments
keywords: gastric low-grade dysplasia; histologic discrepancy; magnifying endoscopy with narrow-band imaging