Upgrade of lesions initially diagnosed as low-grade gastric dysplasia upon forceps biopsy following endoscopic resection

Chan Sik Won, Meeyon Cho, Hyunsoo Kim, Hye Jeong Kim, Ki Tae Suk, Moonyoung Kim, Jae Woo Kim, Soonkoo Baik, Sang Ok Kwon

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background/Aims: Gastric dysplasia is generally accepted to be the precursor lesion of gastric carcinoma. Approximately 25% to 35% of histological diagnoses based on endoscopic forcep biopsies for gastric dysplastic lesions change following endoscopic resection (ER). The aim of this study was to determine the predictive endoscopic features of high-grade gastric dysplasia (HGD) or early gastric cancer (EGC) following ER for lesions initially diagnosed as low-grade dysplasia (LGD) by a forceps biopsy. Methods: To determine predictive variables for upgraded histology (LGD to HGD or EGC). The lesion size, gross endoscopic appearance, location, and surface nodularity or redness as well as the presence of a depressed portion, Helicobacter pylori infection, and intestinal metaplasia were retrospectively investigated. Results: Among 251 LGDs diagnosed by an initial forceps biopsy, the diagnoses of 100 lesions (39.8%) changed following the ER; 56 of 251 LGDs (22.3%) were diagnosed as HGD, 39 (15.5%) as adenocarcinoma, and 5 (2.0%) as chronic gastritis. In a univariate analysis, large lesions (>15 mm), those with a depressed portion, and those with surface nodularity were significantly correlated with a upgraded histology classification following ER. In a multivariate analysis, a large size (>15 mm; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.46 to 5.43) and a depressed portion in the lesion (OR, 2.7; 95% CI, 1.44 to 5.03) were predictive factors for upgraded histology following ER. Conclusions: Our study shows that a substantial proportion of diagnoses of low-grade gastric dysplasias based on forceps biopsies were not representative of the entire lesion. We recommend ER for lesions with a depressed portion and for those larger than 15 mm.

Original languageEnglish
Pages (from-to)187-193
Number of pages7
JournalGut and Liver
Volume5
Issue number2
DOIs
Publication statusPublished - 2011 Jun 1

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Surgical Instruments
Stomach
Biopsy
Histology
Stomach Neoplasms
Odds Ratio
Confidence Intervals
Metaplasia
Helicobacter Infections
Gastritis
Helicobacter pylori
Adenocarcinoma
Multivariate Analysis
Carcinoma

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

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title = "Upgrade of lesions initially diagnosed as low-grade gastric dysplasia upon forceps biopsy following endoscopic resection",
abstract = "Background/Aims: Gastric dysplasia is generally accepted to be the precursor lesion of gastric carcinoma. Approximately 25{\%} to 35{\%} of histological diagnoses based on endoscopic forcep biopsies for gastric dysplastic lesions change following endoscopic resection (ER). The aim of this study was to determine the predictive endoscopic features of high-grade gastric dysplasia (HGD) or early gastric cancer (EGC) following ER for lesions initially diagnosed as low-grade dysplasia (LGD) by a forceps biopsy. Methods: To determine predictive variables for upgraded histology (LGD to HGD or EGC). The lesion size, gross endoscopic appearance, location, and surface nodularity or redness as well as the presence of a depressed portion, Helicobacter pylori infection, and intestinal metaplasia were retrospectively investigated. Results: Among 251 LGDs diagnosed by an initial forceps biopsy, the diagnoses of 100 lesions (39.8{\%}) changed following the ER; 56 of 251 LGDs (22.3{\%}) were diagnosed as HGD, 39 (15.5{\%}) as adenocarcinoma, and 5 (2.0{\%}) as chronic gastritis. In a univariate analysis, large lesions (>15 mm), those with a depressed portion, and those with surface nodularity were significantly correlated with a upgraded histology classification following ER. In a multivariate analysis, a large size (>15 mm; odds ratio [OR], 2.8; 95{\%} confidence interval [CI], 1.46 to 5.43) and a depressed portion in the lesion (OR, 2.7; 95{\%} CI, 1.44 to 5.03) were predictive factors for upgraded histology following ER. Conclusions: Our study shows that a substantial proportion of diagnoses of low-grade gastric dysplasias based on forceps biopsies were not representative of the entire lesion. We recommend ER for lesions with a depressed portion and for those larger than 15 mm.",
author = "Won, {Chan Sik} and Meeyon Cho and Hyunsoo Kim and Kim, {Hye Jeong} and Suk, {Ki Tae} and Moonyoung Kim and Kim, {Jae Woo} and Soonkoo Baik and Kwon, {Sang Ok}",
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Upgrade of lesions initially diagnosed as low-grade gastric dysplasia upon forceps biopsy following endoscopic resection. / Won, Chan Sik; Cho, Meeyon; Kim, Hyunsoo; Kim, Hye Jeong; Suk, Ki Tae; Kim, Moonyoung; Kim, Jae Woo; Baik, Soonkoo; Kwon, Sang Ok.

In: Gut and Liver, Vol. 5, No. 2, 01.06.2011, p. 187-193.

Research output: Contribution to journalArticle

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T1 - Upgrade of lesions initially diagnosed as low-grade gastric dysplasia upon forceps biopsy following endoscopic resection

AU - Won, Chan Sik

AU - Cho, Meeyon

AU - Kim, Hyunsoo

AU - Kim, Hye Jeong

AU - Suk, Ki Tae

AU - Kim, Moonyoung

AU - Kim, Jae Woo

AU - Baik, Soonkoo

AU - Kwon, Sang Ok

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N2 - Background/Aims: Gastric dysplasia is generally accepted to be the precursor lesion of gastric carcinoma. Approximately 25% to 35% of histological diagnoses based on endoscopic forcep biopsies for gastric dysplastic lesions change following endoscopic resection (ER). The aim of this study was to determine the predictive endoscopic features of high-grade gastric dysplasia (HGD) or early gastric cancer (EGC) following ER for lesions initially diagnosed as low-grade dysplasia (LGD) by a forceps biopsy. Methods: To determine predictive variables for upgraded histology (LGD to HGD or EGC). The lesion size, gross endoscopic appearance, location, and surface nodularity or redness as well as the presence of a depressed portion, Helicobacter pylori infection, and intestinal metaplasia were retrospectively investigated. Results: Among 251 LGDs diagnosed by an initial forceps biopsy, the diagnoses of 100 lesions (39.8%) changed following the ER; 56 of 251 LGDs (22.3%) were diagnosed as HGD, 39 (15.5%) as adenocarcinoma, and 5 (2.0%) as chronic gastritis. In a univariate analysis, large lesions (>15 mm), those with a depressed portion, and those with surface nodularity were significantly correlated with a upgraded histology classification following ER. In a multivariate analysis, a large size (>15 mm; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.46 to 5.43) and a depressed portion in the lesion (OR, 2.7; 95% CI, 1.44 to 5.03) were predictive factors for upgraded histology following ER. Conclusions: Our study shows that a substantial proportion of diagnoses of low-grade gastric dysplasias based on forceps biopsies were not representative of the entire lesion. We recommend ER for lesions with a depressed portion and for those larger than 15 mm.

AB - Background/Aims: Gastric dysplasia is generally accepted to be the precursor lesion of gastric carcinoma. Approximately 25% to 35% of histological diagnoses based on endoscopic forcep biopsies for gastric dysplastic lesions change following endoscopic resection (ER). The aim of this study was to determine the predictive endoscopic features of high-grade gastric dysplasia (HGD) or early gastric cancer (EGC) following ER for lesions initially diagnosed as low-grade dysplasia (LGD) by a forceps biopsy. Methods: To determine predictive variables for upgraded histology (LGD to HGD or EGC). The lesion size, gross endoscopic appearance, location, and surface nodularity or redness as well as the presence of a depressed portion, Helicobacter pylori infection, and intestinal metaplasia were retrospectively investigated. Results: Among 251 LGDs diagnosed by an initial forceps biopsy, the diagnoses of 100 lesions (39.8%) changed following the ER; 56 of 251 LGDs (22.3%) were diagnosed as HGD, 39 (15.5%) as adenocarcinoma, and 5 (2.0%) as chronic gastritis. In a univariate analysis, large lesions (>15 mm), those with a depressed portion, and those with surface nodularity were significantly correlated with a upgraded histology classification following ER. In a multivariate analysis, a large size (>15 mm; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.46 to 5.43) and a depressed portion in the lesion (OR, 2.7; 95% CI, 1.44 to 5.03) were predictive factors for upgraded histology following ER. Conclusions: Our study shows that a substantial proportion of diagnoses of low-grade gastric dysplasias based on forceps biopsies were not representative of the entire lesion. We recommend ER for lesions with a depressed portion and for those larger than 15 mm.

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