Clinicopathologic factors and outcomes of histologic discrepancy between differentiated and undifferentiated types after endoscopic resection of early gastric cancer

Choong Nam Shim, Hyunki Kim, Dong Wook Kim, Hyun Soo Chung, Jun Chul Park, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee

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14 Citations (Scopus)

Abstract

Background: Histologic discrepancies among specimens obtained by forceps biopsy and endoscopic resection (ER) between the differentiated and undifferentiated types often occur in early gastric cancer (EGC). This study aimed to evaluate the predictive clinicopathologic characteristics and clinical implications of histologic discrepancies in EGC. Methods: From August 2005 to March 2012, 596 lesions from 579 patients underwent ER for EGC. The lesions studied were diagnosed as the differentiated histologic type from forceps biopsy specimens. The lesions were grouped according to the occurrence of histologic discrepancy between the differentiated and undifferentiated types in specimens obtained by ER as concordant (n = 570) or discordant (n = 26). The main outcome measures were en bloc resection, complete resection, and curative resection rates. Results: The histologic discrepancy rate was 4.4 % among the studied lesions. Larger size, lesion location in the mid third of the stomach, easy friability, exudates, and submucosal invasion shown on endoscopic ultrasound were significantly related to histologic discrepancy in the univariate analysis. In the multivariate analysis, lesion location in the mid third of the stomach [odds ratio (OR) 5.34, 95 % confidence interval (CI) 1.59-19.13] and easy friability (OR 29.26, 95 % CI 2.30 to >999.9) were significant factors associated with histologic discrepancy. The complete resection and curative resection rates were significantly lower and the additional operation rates after ER were significantly higher in the discordant group. Conclusions: The EGCs with histologic discrepancy between the differentiated and undifferentiated types changed the therapeutic outcomes of ER. Easily friable lesions located in the mid third of the stomach carry a significant risk for histologic discrepancy in undifferentiated histology when ER of EGCs is performed.

Original languageEnglish
Pages (from-to)2097-2105
Number of pages9
JournalSurgical endoscopy
Volume28
Issue number7
DOIs
Publication statusPublished - 2014 Jul

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Stomach Neoplasms
Stomach
Surgical Instruments
Odds Ratio
Confidence Intervals
Biopsy
Exudates and Transudates
Histology
Multivariate Analysis
Outcome Assessment (Health Care)
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Shim, Choong Nam ; Kim, Hyunki ; Kim, Dong Wook ; Chung, Hyun Soo ; Park, Jun Chul ; Lee, Hyuk ; Shin, Sung Kwan ; Lee, Sang Kil ; Lee, Yong Chan. / Clinicopathologic factors and outcomes of histologic discrepancy between differentiated and undifferentiated types after endoscopic resection of early gastric cancer. In: Surgical endoscopy. 2014 ; Vol. 28, No. 7. pp. 2097-2105.
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title = "Clinicopathologic factors and outcomes of histologic discrepancy between differentiated and undifferentiated types after endoscopic resection of early gastric cancer",
abstract = "Background: Histologic discrepancies among specimens obtained by forceps biopsy and endoscopic resection (ER) between the differentiated and undifferentiated types often occur in early gastric cancer (EGC). This study aimed to evaluate the predictive clinicopathologic characteristics and clinical implications of histologic discrepancies in EGC. Methods: From August 2005 to March 2012, 596 lesions from 579 patients underwent ER for EGC. The lesions studied were diagnosed as the differentiated histologic type from forceps biopsy specimens. The lesions were grouped according to the occurrence of histologic discrepancy between the differentiated and undifferentiated types in specimens obtained by ER as concordant (n = 570) or discordant (n = 26). The main outcome measures were en bloc resection, complete resection, and curative resection rates. Results: The histologic discrepancy rate was 4.4 {\%} among the studied lesions. Larger size, lesion location in the mid third of the stomach, easy friability, exudates, and submucosal invasion shown on endoscopic ultrasound were significantly related to histologic discrepancy in the univariate analysis. In the multivariate analysis, lesion location in the mid third of the stomach [odds ratio (OR) 5.34, 95 {\%} confidence interval (CI) 1.59-19.13] and easy friability (OR 29.26, 95 {\%} CI 2.30 to >999.9) were significant factors associated with histologic discrepancy. The complete resection and curative resection rates were significantly lower and the additional operation rates after ER were significantly higher in the discordant group. Conclusions: The EGCs with histologic discrepancy between the differentiated and undifferentiated types changed the therapeutic outcomes of ER. Easily friable lesions located in the mid third of the stomach carry a significant risk for histologic discrepancy in undifferentiated histology when ER of EGCs is performed.",
author = "Shim, {Choong Nam} and Hyunki Kim and Kim, {Dong Wook} and Chung, {Hyun Soo} and Park, {Jun Chul} and Hyuk Lee and Shin, {Sung Kwan} and Lee, {Sang Kil} and Lee, {Yong Chan}",
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Clinicopathologic factors and outcomes of histologic discrepancy between differentiated and undifferentiated types after endoscopic resection of early gastric cancer. / Shim, Choong Nam; Kim, Hyunki; Kim, Dong Wook; Chung, Hyun Soo; Park, Jun Chul; Lee, Hyuk; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan.

In: Surgical endoscopy, Vol. 28, No. 7, 07.2014, p. 2097-2105.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinicopathologic factors and outcomes of histologic discrepancy between differentiated and undifferentiated types after endoscopic resection of early gastric cancer

AU - Shim, Choong Nam

AU - Kim, Hyunki

AU - Kim, Dong Wook

AU - Chung, Hyun Soo

AU - Park, Jun Chul

AU - Lee, Hyuk

AU - Shin, Sung Kwan

AU - Lee, Sang Kil

AU - Lee, Yong Chan

PY - 2014/7

Y1 - 2014/7

N2 - Background: Histologic discrepancies among specimens obtained by forceps biopsy and endoscopic resection (ER) between the differentiated and undifferentiated types often occur in early gastric cancer (EGC). This study aimed to evaluate the predictive clinicopathologic characteristics and clinical implications of histologic discrepancies in EGC. Methods: From August 2005 to March 2012, 596 lesions from 579 patients underwent ER for EGC. The lesions studied were diagnosed as the differentiated histologic type from forceps biopsy specimens. The lesions were grouped according to the occurrence of histologic discrepancy between the differentiated and undifferentiated types in specimens obtained by ER as concordant (n = 570) or discordant (n = 26). The main outcome measures were en bloc resection, complete resection, and curative resection rates. Results: The histologic discrepancy rate was 4.4 % among the studied lesions. Larger size, lesion location in the mid third of the stomach, easy friability, exudates, and submucosal invasion shown on endoscopic ultrasound were significantly related to histologic discrepancy in the univariate analysis. In the multivariate analysis, lesion location in the mid third of the stomach [odds ratio (OR) 5.34, 95 % confidence interval (CI) 1.59-19.13] and easy friability (OR 29.26, 95 % CI 2.30 to >999.9) were significant factors associated with histologic discrepancy. The complete resection and curative resection rates were significantly lower and the additional operation rates after ER were significantly higher in the discordant group. Conclusions: The EGCs with histologic discrepancy between the differentiated and undifferentiated types changed the therapeutic outcomes of ER. Easily friable lesions located in the mid third of the stomach carry a significant risk for histologic discrepancy in undifferentiated histology when ER of EGCs is performed.

AB - Background: Histologic discrepancies among specimens obtained by forceps biopsy and endoscopic resection (ER) between the differentiated and undifferentiated types often occur in early gastric cancer (EGC). This study aimed to evaluate the predictive clinicopathologic characteristics and clinical implications of histologic discrepancies in EGC. Methods: From August 2005 to March 2012, 596 lesions from 579 patients underwent ER for EGC. The lesions studied were diagnosed as the differentiated histologic type from forceps biopsy specimens. The lesions were grouped according to the occurrence of histologic discrepancy between the differentiated and undifferentiated types in specimens obtained by ER as concordant (n = 570) or discordant (n = 26). The main outcome measures were en bloc resection, complete resection, and curative resection rates. Results: The histologic discrepancy rate was 4.4 % among the studied lesions. Larger size, lesion location in the mid third of the stomach, easy friability, exudates, and submucosal invasion shown on endoscopic ultrasound were significantly related to histologic discrepancy in the univariate analysis. In the multivariate analysis, lesion location in the mid third of the stomach [odds ratio (OR) 5.34, 95 % confidence interval (CI) 1.59-19.13] and easy friability (OR 29.26, 95 % CI 2.30 to >999.9) were significant factors associated with histologic discrepancy. The complete resection and curative resection rates were significantly lower and the additional operation rates after ER were significantly higher in the discordant group. Conclusions: The EGCs with histologic discrepancy between the differentiated and undifferentiated types changed the therapeutic outcomes of ER. Easily friable lesions located in the mid third of the stomach carry a significant risk for histologic discrepancy in undifferentiated histology when ER of EGCs is performed.

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