The Diagnostic Accuracy of Endoscopic Biopsy for Gastric Dysplasia

  • Lee, Sung-Bae (Department of Surgery, College of Medicine, CHA University) ;
  • Kang, Hye-Yun (Department of Pathogy, College of Medicine, CHA University) ;
  • Kim, Kwang-Il (Department of Pathogy, College of Medicine, CHA University) ;
  • Ahn, Dae-Ho (Department of Surgery, College of Medicine, CHA University)
  • Received : 2010.08.19
  • Accepted : 2010.10.06
  • Published : 2010.12.30


Purpose: There is controversy over the treatment for low grade dysplasia, while resection is recommended for high grade dysplasia. But the concordance of the grade of dysplasia between pre- and post-resection is low because of sampling errors with endoscopic biopsy. We attempted to establish a clearer direction for the treatment of dysplasia by clarifying the discrepancy between the pre- and postresection diagnoses. Materials and Methods: We performed a retrospective review of 126 patients who had undergone resection with the diagnosis of dysplasia on biopsy at Bundang CHA Hospital from 1999 to 2009. Results: Seventy patients were diagnosed with low grade dysplasia and 56 patients were diagnosed with high grade dysplasia. Among the 33 patients who received gastrectomy with lymph node dissec-tion, 30 patients were revealed to have invasive cancers and 4 patients showed lymph node metastasis. Discordance between the diagnoses from biopsy and resection occurred in 55 patients (44%). There was no correlation on the comparative analysis between the size, location or gross type of lesion and the grade of dysplasia. Conclusions: The rate of discordance between the diagnoses of endoscopic biopsy and the post resection pathologic report was as high as 44%. Endoscopic mucosal resection was not sufficient for some patients who were diagnosed with dysplasia on biopsy due to the presence of lymph node metastasis. It is necessary to be prudent when determining the follow-up and treatment based solely on the result of the biopsy.


  1. Ming SC, Bajtai A, Correa P, Elster K, Jarvi OH, Munoz N, et al. Gastric dysplasia. Significance and pathologic criteria. Cancer 1984;54:1794-1801.<1794::AID-CNCR2820540907>3.0.CO;2-W
  2. Morson BC, Sobin LH, Grundmann E, Johansen A, Nagayo T, Serck-Hanssen A. Precancerous conditions and epithelial dysplasia in the stomach. J Clin Pathol 1980;33:711-721.
  3. Ghandur-Mnaymneh L, Paz J, Roldan E, Cassady J. Dysplasia of nonmetaplastic gastric mucosa. A proposal for its classifi cation and its possible relationship to diff use-type gastric carcinoma. Am J Surg Pathol 1988;12:96-114.
  4. Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, et al. Th e Vienna classifi cation of gastrointestinal epithelial neoplasia. Gut 2000;47:251-255.
  5. Bogomoletz WV. Early gastric cancer. Am J Surg Pathol 1984;8:381-391.
  6. You WC, Blot WJ, Li JY, Chang YS, Jin ML, Kneller R, et al. Precancerous gastric lesions in a population at high risk of stomach cancer. Cancer Res 1993;53:1317-1321.
  7. Tosi P, Filipe MI, Luzi P, Miracco C, Santopietro R, Lio R, et al. Gastric intestinal metaplasia type III cases are classifi ed as low-category dysplasia on the basis of morphometry. J Pathol 1993;169:73-78.
  8. Choi JY, Lee SH. Th erapeutic strategy and clinicopathologic analysis of gastric epithelial dysplasia. J Korean Surg Soc 2004;67:192-197.
  9. Farinati F, Rugge M, Di Mario F, Valiante F, Baffa R. Early and advanced gastric cancer in the follow-up of moderate and severe gastric dysplasia patients. A prospective study. I.G.G.E.D.--Interdisciplinary Group on Gastric Epithelial Dysplasia. Endoscopy 1993;25:261-264.
  10. Bearzi I, Brancorsini D, Santinelli A, Rezai B, Mannello B, Ranaldi R. Gastric dysplasia: a ten-year follow-up study. Pathol Res Pract 1994;190:61-68.
  11. Hansson LE, Lindgren A, Nyren O. Can endoscopic biopsy specimens be used for reliable Lauren classifi cation of gastric cancer? Scand J Gastroenterol 1996;31:711-715.
  12. Palli D, Bianchi S, Cipriani F, Duca P, Amorosi A, Avellini C, et al. Reproducibility of histologic classifi cation of gastric cancer. Br J Cancer 1991;63:765-768.
  13. Kim YD, Cho JY, Jung IS, Koh BM, Hong SJ, Ryu CB, et al. Comparison of endoscopic forcep biopsy and the histopathologic diagnosis aft er endoscopic submucosal dissection. Korean J Gastrointest Endosc 2009;38:188-192.
  14. Hwang JY, Park KS, Hwang JS, Ahn SH, Park SK. Histological comparison of endoscopic forceps biopsy with endoscopic resection in gastric mucosal elevated lesion. Korean J Gastrointest Endosc 2003;26:68-72.
  15. Kim EY, Kim JJ, Kim B, Park SM. Treatment of gastric epithelial dysplasia that is diagnosed by endoscopic biopsy. J Korean Gastric Cancer Assoc 2010;10:1-4.
  16. Min JS, Noh SH, Kim HG, Yoo CH, Lee YC. Therapeutic strategy for gastric epithelial dysplasia. Korean J Gastroenterol 1998;32:176-183.
  17. Isaacson P. Biopsy appearances easily mistaken for malignancy in gastrointestinal endoscopy. Histopathology 1982;6:377-389.
  18. Weinstein WM, Goldstein NS. Gastric dysplasia and its management. Gastroenterology 1994;107:1543-1545.
  19. Lee YM, Oh KS, Cho KH, Jang HJ, Lee SH, Seol SY, et al. A prospective study of gastric epithelial dysplasia. Korean J Med 1996;50:371-377.
  20. Takekoshi T, Baba Y, Ota H, Kato Y, Yanagisawa A, Takagi K, et al. Endoscopic resection of early gastric carcinoma: results of a retrospective analysis of 308 cases. Endoscopy 1994;26:352-358.
  21. Rugge M, Correa P, Dixon MF, Hattori T, Leandro G, Lewin K, et al. Gastric dysplasia: the Padova international classifi cation. Am J Surg Pathol 2000;24:167-176.
  22. Kokkola A, Haapiainen R, Laxen F, Puolakkainen P, Kivilaakso E, Virtamo J, et al. Risk of gastric carcinoma in patients with mucosal dysplasia associated with atrophic gastritis: a follow up study. J Clin Pathol 1996;49:979-984.
  23. Kim JW, Yu WS. Management of gastric severe dysplasia. Korean J Pathol 1997;31:389-400.
  24. Correa P, Shiao YH. Phenotypic and genotypic events in gastric carcinogenesis. Cancer Res 1994;54(7 Suppl):1941s-1943s.
  25. Yoon WJ, Lee DH, Lee KL, Chang DK, Kim BG, Kim JW, et al. Th e discordance between endoscopic forceps biopsy and endoscopic resection specimen of gastric polyps. Korean J Med 2005;69:481-486.
  26. Choi SR. Treatment of gastric epithelial dysplasia. J Korean Gastric Cancer Assoc 2002;2:140-144.