The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Negative pathology after endoscopic resection of gastric epithelial neoplasms: importance of pit dysplasia

  • Jhi, Joon Hyung (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Gwang Ha (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Ahrong (Biomedical Research Institute, Pusan National University Hospital) ;
  • Kim, Young-Geum (Biomedical Research Institute, Pusan National University Hospital) ;
  • Hwang, Cheong Su (Biomedical Research Institute, Pusan National University Hospital) ;
  • Lee, Sojeong (Biomedical Research Institute, Pusan National University Hospital) ;
  • Lee, Bong Eun (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Song, Geun Am (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Park, Do Youn (Department of Internal Medicine, Pusan National University School of Medicine)
  • Received : 2015.12.08
  • Accepted : 2015.09.21
  • Published : 2017.07.01
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Abstract

Background/Aims: Endoscopic resection (ER) is a well-established treatment modality for gastric epithelial neoplasm. However, there is a discrepancy between forceps biopsy and ER specimen pathology, including a negative pathologic diagnosis (NPD) after ER. It has been suggested that pit dysplasia (PD) is a subtype of gastric dysplasia, and the aim of this study was to assess the significance of PD in cases with NPD after ER for early gastric neoplasms. Methods: After ER, 29 NPD lesions that had an associated pretreatment forceps biopsy specimen, were correctly targeted during ER, and had no cautery artifact on the resected specimen were included in this study. Results: Sixteen lesions showed PD and 13 had no neoplastic pathology. The initial pretreatment forceps biopsy diagnoses of 29 NPD lesions were low-grade dysplasia (LGD) in 17 lesions, high-grade dysplasia (HGD) in seven lesions, and adenocarcinoma in five lesions, which after review were revised to PD in 19 lesions, LGD in four lesions, adenocarcinoma in two lesions, and no neoplastic pathology in four lesions. Overall, nine lesions (31%) were small enough to be removed by forceps biopsy, four NPD lesions (14%) were initially misinterpreted as neoplastic lesions, and 16 PD lesions (55%) were misinterpreted as NPD lesions on ER slides. Conclusions: Approximately half of the lesions initially diagnosed as LGD or HGD were subsequently classified as PD. Therefore, including PD as a subtype of gastric dysplasia could reduce the diagnostic discrepancy between initial forceps biopsy and ER specimens.

Keywords

Acknowledgement

Supported by : Ministry for Health, Welfare and Family Affairs

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