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Original Article
Pathological differences between forceps biopsy specimens and endoscopic resection specimens in early gastric cancer patients - Joo Seok Kim, Sae Hee Kim, Min Gyu Kim, Ah Jeong Ryu, Il Hwan Ryu, Jae Jun Lee, Jae Woong Jeon, Ji Wook Choi, Anna Kim
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Kosin Medical Journal 2014;29(2):117-124.
DOI: https://doi.org/10.7180/kmj.2014.29.2.117
Published online: December 18, 2014
1Department of Internal Medicine, Eulji University Hospital, Daejon, Korea
- Corresponding Author : Sae Hee Kim, Department of Internal Medicine, Eulji University Hospital, 1306, Dunsan-dong, Seo-gu, Daejeon, 302-799, Korea TEL: +82-42-611-3065 FAX: +82-42-611-3947 E-mail: cozy129@eulji.ac.kr
• Received: August 20, 2013 • Accepted: December 16, 2013
Copyright © 2014 Kosin University School of Medicine Proceedings
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
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Objective:
- Endoscopic resection(ER) is effective therapy on EGC and which is treated according to the histological diagnosis of forcep biopsy. But sometimes the histological diagnosis of forcep biopsy and post-ER does not match with each other and it might lead to wrong treatment. The aim of this study is to find the frequency of histologic differences between forcep biopsy and post-ER, and to confirm the characteristics of lesions which make errors.
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Methods:
- We selected the confirmed cancer cases of 141 patients of 1359 gastric tumor lesions which were treated under the ER in Eulji university hospital from May 2005 to March 2013. They were sorted by the age and sex of patient, location of lesion, present of ulcer and depression to identify the discordance between forcep biopsy and ER. The discordant group was compared with non-cancer-diagnosed controlled group, retrospectively.
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Results:
- 70 cases(5.5%) of 1283 cases of “cancer negative” in forceps biopsy were fo䴸nd to be diagnosed cancer on final diagnosis of cancer by post-ER result. In this discordant group showed characteristics of bigger size that are with more frequently in tumor size D15mm(17.9% vs. 31.4%, p=0.03), have depressed lesion(ᄀ 4.3% vs. 41.4%, p<0.01) and have 䴸lceration(2.4% vs.18.6%, p<0.01) than that of 84 control gro䴸p not diagnosed cancer.
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Conclusions:
- In cases of tumor with size D15mm, presented with depressed lesion and ulceration, we should consider combined cancer, even the result of forcep biopsy was negative. Therefore, more careful and accurate resection should be taken with characters listed above.
Table 1.Clinicopatholgical characteristics of the study subjects
Table 2.Pathological differences between forceps biopsy specimens and endoscopic resection specimens
Table 3.Analysis of the Predictable Factors of Pathological Differences between Non-cancer and Cancer after Endoscopic Resection
Table 4.Analysis of the Predictable Factors of Pathological Differences between Non- Poorlv Differentiated and Poorly Differentiated after Endoscopic Resection
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Pathological differences between forceps biopsy specimens and endoscopic resection specimens in early gastric cancer patients
Clinicopatholgical characteristics of the study subjects
| Clinicopatholgical characteristics of 137 patients (141 lesions) | |
| Age, years, median (range) | 67 (41-89) |
| Sex, Male/Fcmale (%) | 100/37 (73.0/27.0) |
| Lociition, n (%) | |
| Upper (cardia, fundus, upper body) | 12(8.5) |
| Mid (mid body, lower body, angle) | 51 (36.2) |
| Lower (antrum, pylorus) | 78 (55.3) |
| Lesion diameter, mm, median (range) | 10(1-50) |
| Gross lypc, n (%) | |
| Protruded | 11 (7.8) |
| Flat elevated | 20(14.2) |
| Flat | 32 (22.7) |
| Flat depressed | 30 (21.3) |
| Depressed or Ulcerative | 4 (2.8) |
| Combined | 44 (31.2) |
| Biopsy pathology, group classification, n (%) | |
| Non-adenomatous neoplasm | 5 (3.5) |
| Adeoma & CIS | 65 (46.1) |
| Adenocarcinoma & other cancers | 71 (50.4) |
| Histological type of cancer, forceps biopsy, n (%) | |
| WD | 42 (59.2) |
| MD | 23 (32.4) |
| PD | 4(5.6) |
| Other cancers (carcinoid tumor, mucinous carcinoma) | 2(2.8) |
| Endoscopic resection method, n (%) | |
| Endoscopic mucosal resection | 27(19.1) |
| Endoscopic submucosal dissection | 114 (80,9) |
Pathological differences between forceps biopsy specimens and endoscopic resection specimens
| Forceps biopsy specimens | Endoscopic resection specimens | ||||||
|---|---|---|---|---|---|---|---|
| Non- adenomatous neoplasm | Adenoma&CIS | Adenocarcinoma | Other cancers | ||||
| WD | MD | PD | |||||
| Non-adenomatous neoplasm (n=5) | - | - | 1 | 1 | 1 | 2 | |
| Adenoma & CIS(n=65) | - | - | 46 | 14 | 4 | i | |
| Adenocarcinoma (n 二 69) | WD (n=42) | 0 | 6 | 24 | 10 | 2 | 0 |
| MD (n-23) | 0 | 1 | 6 | 14 | 2 | 0 | |
| PD (n=4) | 0 | 0 | 0 | 0 | 4 | 0 | |
| Other cancers (n=2) | 0 | 0 | 0 | 0 | 0 | 2 | |
Analysis of the Predictable Factors of Pathological Differences between Non-cancer and Cancer after Endoscopic Resection
| Endoscopic resection specimens | P-value | ||
|---|---|---|---|
| Non-cancer (n=84) | Cancer (n=70) | ||
| Age | |||
| <65 | 50 (59.5%) | 36 (51.4%) | 0.16 |
| ≧ 65 | 34 (40.5%) | 34 (48.6%) | |
| Sex | |||
| Male | 60(71.4%) | 49 (70.0%) | 0.42 |
| Female | 24 (28.6%) | 21 (30.0%) | |
| Location | |||
| Upper | 5 (6.0%) | 7(10.0%) | 0.18 |
| Mid | 27(32.1%) | 29 (41.4%) | 0,12 |
| Lower | 52(61.9%) | 34 (48.6%) | 0.05 |
| Tumor size | |||
| <15 | 69(82.1%) | 48 (68.6%) | 0.03 |
| ≧ 15 | 15 (17.9%) | 22 (31.4%) | |
| Depression | |||
| Present | 12(14.3%) | 29 (41.4%) | <0,01 |
| Absent | 72 (S5.7%) | 41 (58.6%) | |
| Ulceration | |||
| Present | 2 (2.4%) | 13 (18.6%) | <0.01 |
| Absent | 82 (87.6%) | 57(81.4%) | |
Analysis of the Predictable Factors of Pathological Differences between Non- Poorlv Differentiated and Poorly Differentiated after Endoscopic Resection
| Endoscopic resection specimens | P-value | ||
|---|---|---|---|
| Non-PD (n= 23) | PD (n=9) | ||
| Age | |||
| <65 | 52 (42.3%) | 2 (22.2%) | 0.08 |
| ≧ 65 | 71 (57.7%) | 7 (77.8%) | |
| Sex | |||
| Male | 91 (74.0%) | 6 (66.7%) | 0.33 |
| Female | 32 (26.0%) | 3 (33.3%) | |
| Location | |||
| Upper | 10(8,1%) | 0 (0%) | |
| Mid | 43 (35.0%) | 6 (66.7%) | 0.03 |
| Lower | 70 (56.9%) | 3 (33.3%) | 0,07 |
| Tumor size | |||
| <15 | 81 (65.9%) | 6 (66.7%) | 0.48 |
| ≧15 | 42 (34.1%) | 3 (33.3%) | |
| Depression | |||
| Present | 62 (50.4%) | 6 (66.6%) | 0.16 |
| Absent | 6i (49.6%) | 3 (33.3%) | |
| Ulceration | |||
| Present | 32 (26.0%) | 2 (22.2%) | 0.40 |
| Absent | 91 (74.0%) | 7 (77.8%) | |
