The Histologic Discrepancy Between Endoscopic Forceps Biopsy and Endoscopic Resection of Gastric Adenoma and Early Gastric Cancer

초록

Adenomatous polyps are indicated for endoscopic resection because of its potential to carcinoma. However, some clinicians believe that only high grade dysplasia should be resected. AIMS & METHODS: This study was aimed to investigate the discrepancy rate between the histology of the endoscopic biopsy specimen and that of the resected specimen by endoscopic mucosal dissection (EMR), in gastric adenomas and early gastric cancers (EGC). We also analyzed the necessity for resection of low grade dysplasia. We reviewed 152 cases of gastric adenomas and early gastric cancers (EGC), which were treated by EMR from January, 2004 to August, 2007. We analyzed the relationship between the histology of the endoscopic biopsy specimen and the resected specimen. RESULTS: Of the 152 cases, the discrepancy rate was 31.5% (n=48) between the histology of the endoscopic biopsy specimen and the resected specimen. Among the 104 cases of adenoma, 26 cases (25%) revealed discrepancy and 22 cases (45.8%) of EGC revealed discrepancy. Among the 41 cases of high grade dysplasia, 8 cases (19.5%) were confirmed as early gastric cancer after EMR and 3 cases (3.2%) of low grade dysplasia were confirmed as early gastric cancer. The discrepancy rate of adenoma and EGC was high in lesions less than 1 cm, the discrepancy rate of adenoma and EGC was high in type IIc, IIb, respectively. Thelocation of lesions was discordant in antrum and the lower body. CONCLUSION: The histologic discrepancy rate between endoscopic biopsy specimen and resected specimen was 25% for the gastric adenoma and 45.8% for the EGC. Twenty six percentage of low grade hyperplasia were overdiagnosed as high grade dysplasia or EGC. To our knowledge, gastric adenoma should be removed by EMR even though the endoscopic biopsy revealed low grade dysplasia, considering the discrepancy rate between the endoscopic biopsy specimen and resected specimen.