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Endoscopic and histopathological characteristics suggesting the presence of gastric mucosal high grade neoplasia foci in cases initially diagnosed as gastric mucosal low grade neoplasia by forceps biopsy in Korea

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Abstract

Background

As biopsy sites may miss coexisting gastric mucosal high grade neoplasia (HGN) foci, making a diagnosis of gastric mucosal low grade neoplasia (LGN) based only on forceps biopsy specimens can be inaccurate. Therefore, to achieve an accurate diagnosis, endoscopic mucosal resection (EMR) of the entire lesion is required. However, EMR can cause serious complications such as perforation or bleeding. Considering these points, it is necessary to identify the characteristics suggesting coexisting HGN foci in cases initially diagnosed as LGN by forceps biopsy.

Methods

Three hundred and five lesions from 282 consecutive patients were initially diagnosed as LGN by forceps biopsy and later resected using EMR. The still photographs from endoscopies and pathology slides of these lesions were reviewed.

Results

After EMR, 272 lesions (89.2%) were finally diagnosed as LGN and 33 lesions (10.8%) were diagnosed as having HGN foci, including 1 intramucosal carcinoma. Univariate analysis showed that lesions >1.0 cm on endoscopy and lesions with tubulovillous or villous histology on forceps biopsy specimens were significantly more frequently found in cases with HGN than in LGN cases. Multivariate analysis demonstrated that lesion size >1.0 cm on endoscopy and findings of tubulovillous or villous histology on forceps biopsy specimens were independent risk factors for coexisting HGN foci in cases initially diagnosed as LGN by forceps biopsy.

Conclusions

If the lesions diagnosed as LGN by forceps biopsy are >1.0 cm on endoscopy or show tubulovillous or villous histology, EMR might be considered to avoid the risk of missing HGN foci.

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Acknowledgments

This work was supported by a grant from the Samsung Medical Center Clinical Research Development Program (CRS-107-33-3).

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Authors and Affiliations

  1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea

    Byung-Hoon Min, Eun Ran Kim, Jae J. Kim, Jun Haeng Lee, Dong Kyung Chang, Young-Ho Kim, Poong-Lyul Rhee & Jong Chul Rhee

  2. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea

    Kyoung-Mee Kim & Cheol Keun Park

  3. Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

    Hyuk Lee

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  1. Byung-Hoon Min
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Correspondence to Jae J. Kim.

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B.-H. Min and K.-M. Kim contributed equally to this work.

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Min, BH., Kim, KM., Kim, E.R. et al. Endoscopic and histopathological characteristics suggesting the presence of gastric mucosal high grade neoplasia foci in cases initially diagnosed as gastric mucosal low grade neoplasia by forceps biopsy in Korea. J Gastroenterol 46, 17–24 (2011). https://doi.org/10.1007/s00535-010-0289-2

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  • DOI: https://doi.org/10.1007/s00535-010-0289-2

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