title: Pre- and post-ESD discrepancies in clinicopathologic criteria in early gastric cancer: the NECA-Korea ESD for Early Gastric Cancer Prospective Study (N-Keep).
abstract: BACKGROUND
  Discrepancies in the clinicopathologic parameters pre- and post-endoscopic submucosal dissection (ESD) sometimes necessitate additional surgical resection. The aim of this study was to assess such discrepancies in clinicopathologic parameters before and after ESD in the context of reducing the risk of failure of curative ESD.
  
  
  METHODS
  Data on 712 early gastric cancer patients were prospectively collected from 12 university hospitals nationwide. The inclusion criteria were differentiated carcinoma <3 cm in size, no ulceration, submucosal invasion <500 μm, and no metastasis. Clinicopathologic factors were compared retrospectively.
  
  
  RESULTS
  The discrepancy rate was 20.1 % (148/737) and the most common cause of discrepancy was tumor size (64 cases, 8.7 %). Ulceration, undifferentiated histology, and SM2 invasion were found in 34 (4.6 %), 18 (2.4 %), and 51 cases (6.9 %), respectively. Lymphovascular invasion (LVI) was observed in 34 cases (4.6 %). Cases with lesions exceeding 3 cm in size showed more frequent submucosal invasion, an elevated gross morphology, and upper and middle locations (p < 0.05). In the cases with ulceration, depth of invasion (DOI) was deeper than in the cases without ulceration (p = 0.005). Differentiation was correlated with DOI and LVI (p = 0.021 and 0.007). DOI was correlated with tumor size, ulceration, differentiation, LVI, gross type, and location. There were statistically significant differences between mucosal cancer cases and submucosal cancer cases in tumor size, differentiation, ulceration, LVI, and location.
  
  
  CONCLUSIONS
  The overall discrepancy rate was 20.1 %. To reduce this rate, it is necessary to evaluate the DOI very cautiously, because it is correlated with other parameters. In particular, careful checking for SM-invasive cancer is required due to the high incidence of LVI irrespective of the depth of submucosal invasion.
authors.affiliation: Department of Pathology, Inha University School of Medicine, Incheon, Korea.
authors.forename: Joon Mee
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108, Pyung-Dong, Jongro-Ku, Seoul, 110-102, Korea. jhpath.sohn@samsung.com.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Sohn
authors.affiliation: Yonsei University Wonju Christian Hospital, Wonju, Korea.
authors.forename: Mee-Yon
authors.initials: MY
authors.lastname: Cho
authors.affiliation: Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Woo Ho
authors.initials: WH
authors.lastname: Kim
authors.affiliation: Kosin University College of Medicine, Busan, Korea.
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Chang
authors.affiliation: College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Jung
authors.affiliation: National Cancer Center, Seoul, Korea.
authors.forename: Myeong-Cherl
authors.initials: MC
authors.lastname: Kook
authors.affiliation: Soonchunhyang University Hospital, Seoul, Korea.
authors.forename: So-Young
authors.initials: SY
authors.lastname: Jin
authors.affiliation: Korea University College of Medicine, Seoul, Korea.
authors.forename: Yang Seok
authors.initials: YS
authors.lastname: Chae
authors.affiliation: University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea.
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.affiliation: Inje University Busan Paik Hospital, Busan, Korea.
authors.forename: Mi Seon
authors.initials: MS
authors.lastname: Kang
authors.affiliation: Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyunki
authors.initials: H
authors.lastname: Kim
authors.affiliation: Chonnam National University Hwasun Hospital, Hwasun-Gun, Korea.
authors.forename: Jae Hyuk
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Pusan National University College of Medicine, Busan, Korea.
authors.forename: Do Youn
authors.initials: DY
authors.lastname: Park
authors.affiliation: Sungkyunkwan University Samsung Medical Center, Seoul, Korea.
authors.forename: Kyoung Mee
authors.initials: KM
authors.lastname: Kim
authors.affiliation: Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hoguen
authors.initials: H
authors.lastname: Kim
authors.affiliation: Kyunghee University College of Medicine, Seoul, Korea.
authors.forename: Youn Wha
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea.
authors.forename: Seung-Sik
authors.initials: SS
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
authors.forename: Sang Yong
authors.initials: SY
authors.lastname: Seol
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
authors.forename: Na Rae
authors.initials: NR
authors.lastname: Lee
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
authors.forename: Seung-Hee
authors.initials: SH
authors.lastname: Park
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: You
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer; D000069916:Endoscopic Mucosal Resection; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D056910:Republic of Korea; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Discrepancy; Early gastric cancer; Endoscopic submucosal dissection; Indication; Preoperative diagnosis