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, 20 (34), 12233-40

Endoscopic Features Suggesting Gastric Cancer in Biopsy-Proven Gastric Adenoma With High-Grade Neoplasia

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Endoscopic Features Suggesting Gastric Cancer in Biopsy-Proven Gastric Adenoma With High-Grade Neoplasia

Jung Ho Kim et al. World J Gastroenterol.

Abstract

Aim: To elucidate the endoscopic features that predict the cancer following endoscopic submucosal dissection (ESD) in patients with high-grade neoplasia (HGN).

Methods: We retrospectively analyzed the medical records of patients who underwent ESD of gastric neoplasms from January 2007 to September 2010. ESD was performed in 555 cases involving 550 patients. A total of 112 lesions from 110 consecutive patients were initially diagnosed as HGN without cancer by forceps biopsy, and later underwent ESD. We classified lesions into two groups according to histologic discrepancies between the biopsy and ESD diagnosis. Gastric adenoma in the final diagnosis by ESD specimens were defined as adenoma group. Lesions with coexisting cancer after ESD were defined as cancer group.

Results: The mean age was 65.3 years, and 81 patients were male. There was no significant difference in the age or gender distribution between the adenoma (n = 52) and cancer (n = 60) groups. Thirty-six of these lesions (32.1%) showed histologic concordance between the forceps biopsy and ESD specimens, 16 (14.3%) showed a downgraded histology (low-grade neoplasia), and 60 (53.6%) showed an upgraded histology (cancer). A red color change of the mucosal surface on endoscopy was found in 27/52 (51.9%) of cases in the adenoma group and in 46/60 (76.7%) of cases in the cancer group (P = 0.006). Ulceration of the mucosal surface on endoscopy was found in 5 (9.6%) of 52 lesions in the adenoma group and in 17 (28.3%) of 60 lesions in the cancer group (P = 0.013). In the multivariate analysis, a reddish surface color change and mucosal ulceration were significant predictive factors correlated with cancer after ESD of the HGN by forceps biopsy.

Conclusion: HGN with a red color change or mucosal ulceration correlated with the presence of gastric cancer. These finding may help to guide the diagnosis and treatment.

Keywords: Adenoma; Carcinoma; Dissection; Endoscopy; Neoplasms; Risk factors; Stomach.

Figures

Figure 1
Figure 1
Endoscopic and pathologic findings in a 66-year-old female patient with low-grade neoplasia. In this case, forceps biopsy specimens showed high-grade neoplasia, but endoscopic submucosal dissection (ESD) revealed low-grade neoplasia. A, B: A 22-mm, type 0-IIb lesion was observed in the greater curvature aspect of the antrum. This lesion had a nodular change; C: There was artificial ulceration after successful ESD; D-F: The pathologic findings in the ESD specimen showed a tubular adenoma with low-grade neoplasia. The glands had a similar shape and were slightly crowded with a regular arrangement, and the nuclei were basally oriented, spindle-shaped, and mildly hyperchromatic (D: HE stain, × 12.5; E: HE stain, × 40; F: HE stain, × 200).
Figure 2
Figure 2
Endoscopic and pathologic findings in a 51-year-old male patient with mucosal cancer. In this case, forceps biopsy specimens showed high-grade neoplasia, but endoscopic submucosal dissection (ESD) revealed adenocarcinoma. A, B: An 8-mm, type 0-IIc lesion was observed in the greater curvature aspect of the antrum. This lesion had a smooth surface, red color change, and mucosal ulceration; C: There was artificial ulceration after successful ESD; D-F: The pathologic findings in the ESD specimen showed a tubular adenocarcinoma with focal areas of invasion into the lamina propria. The carcinoma cells have hyperchromatic nuclei with irregular nuclear membranes and prominent nuclei (D: HE stain, × 12.5; E: HE stain, × 40; F: HE stain, × 200).

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