Spectrum of final pathological diagnosis of gastric adenoma after endoscopic resection

• Published in: World journal of gastroenterology : WJG Vol. 17; no. 47; pp. 5177 - 5183
• Main Authors: Nam, Kwan Woo, Song, Kyu Sang, Lee, Heon Young, Lee, Byung Seok, Seong, Jae Kyu, Kim, Seok Hyun, Moon, Hee Seok, Lee, Eaum Seok, Jeong, Hyun Yong
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co., Limited 21.12.2011
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adenoma - diagnosis; Adenoma - pathology; Adenoma - surgery; Aged; Biopsy - methods; Brief; Female; Gastroscopy - methods; Humans; Hyperplasia - pathology; Male; Middle Aged; Retrospective Studies; Risk Factors; Stomach Neoplasms - diagnosis; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Endoscopic mucosal resection; Endoscopic submucosal dissection; Discrepancy; Adenoma; High grade dysplasia
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v17.i47.5177

AIM： To investigate how many discrepancies occur in patients before and after endoscopic treatment of referred adenoma and the reason for these results. METHODS： We retrospectively reviewed data from 554 cases of 534 patients who were referred from primary care centres for adenoma treatment and treated for endoscopic mucosal resection （EMR） or endoscopic submucosal dissection （ESD） at Chungnam National University Hospital, from July 2006 to June 2009. Reendoscopy was examined in 142 cases and biopsywas performed in 108 cases prior to treatment. Three endoscopists （1, 2 and 3） performed all EMRs or ESDs and three pathologists （1, 2 and 3） diagnosed most of the cases. Transfer notes, medical records and endoscopic pictures of these cases were retrospectively reviewed and analyzed. RESULTS： Adenocarcinoma was 72 （13.0%） cases in total 554 cases after endoscopic treatment of referred adenoma. When the grade of dysplasia was high （55.0%）, biopsy number was more than three （22.7%）, size was no smaller than 2.0 cm （23.2%）, morphologic type was depressed （35.8%） or yamada type Ⅳ （100%）, and color was red （30.9%） or mixed-or-undetermined （25.0%）, it had much more malignancy rate than the others （P 〈 0.05）. All 18 cases diagnosed as adenocarcinoma in the re-endoscopic forceps biopsy were performed by endoscopist 1. There were different malignancy rates according to the pathologist （P = 0.027）. CONCLUSION： High grade dysplasia is the most important factor for predicting malignancy as a final pathologic diagnosis before treating the referred gastric adenoma. This discrepancy can occur mainly through inappropriately selecting a biopsy site where cancer cells do not exist, but it also depends on the pathologist to some extent.