Brief Article
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World J Gastroenterol. Dec 21, 2011; 17(47): 5177-5183
Published online Dec 21, 2011. doi: 10.3748/wjg.v17.i47.5177
Spectrum of final pathological diagnosis of gastric adenoma after endoscopic resection
Kwan Woo Nam, Kyu Sang Song, Heon Young Lee, Byung Seok Lee, Jae Kyu Seong, Seok Hyun Kim, Hee Seok Moon, Eaum Seok Lee, Hyun Yong Jeong
Kwan Woo Nam, Gastroenterology Center, Sun Hospital, Daejeon 301-725, South Korea
Kyu Sang Song, Pathologic Department, Chung-Nam National University Hospital, Daejeon 301-721, South Korea
Heon Young Lee, Byung Seok Lee, Jae Kyu Seong, Seok Hyun Kim, Hee Seok Moon, Eaum Seok Lee, Hyun Yong Jeong, Gastroenterology Unit of Internal Medicine Department, Chung-Nam National University Hospital, Daejeon 301-721, South Korea
Author contributions: Nam KW and Jeong HY performed the majority of the research; Song KS provided pathologic advises and, along with Jeong HY, was also involved in editing the manuscript; Moon HS, Lee ES, Lee HY, Lee BS, Seong JK and Kim SH provided the collection of all the human material in addition to collecting the medical record reviews and analysis for this work; Jeong HY designed the study and Nam KW wrote the manuscript.
Supported by Chung-Nam National University Hospital Fund
Correspondence to: Dr. Hyun Yong Jeong, Gastroenterology Unit of Internal Medicine Department, Chung-Nam National University Hospital, Daejeon 301-721, South Korea. jeonghy@cnuh.co.kr
Telephone: +82-42-2807159 Fax: +82-42-2544553
Received: September 19, 2010
Revised: January 25, 2011
Accepted: February 2, 2011
Published online: December 21, 2011
Abstract

AIM: To investigate how many discrepancies occur in patients before and after endoscopic treatment of referred adenoma and the reason for these results.

METHODS: We retrospectively reviewed data from 554 cases of 534 patients who were referred from primary care centres for adenoma treatment and treated for endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) at Chungnam National University Hospital, from July 2006 to June 2009. Re-endoscopy was examined in 142 cases and biopsy was performed in 108 cases prior to treatment. Three endoscopists (1, 2 and 3) performed all EMRs or ESDs and three pathologists (1, 2 and 3) diagnosed most of the cases. Transfer notes, medical records and endoscopic pictures of these cases were retrospectively reviewed and analyzed.

RESULTS: Adenocarcinoma was 72 (13.0%) cases in total 554 cases after endoscopic treatment of referred adenoma. When the grade of dysplasia was high (55.0%), biopsy number was more than three (22.7%), size was no smaller than 2.0 cm (23.2%), morphologic type was depressed (35.8%) or yamada type IV (100%), and color was red (30.9%) or mixed-or-undetermined (25.0%), it had much more malignancy rate than the others (P < 0.05). All 18 cases diagnosed as adenocarcinoma in the re-endoscopic forceps biopsy were performed by endoscopist 1. There were different malignancy rates according to the pathologist (P = 0.027).

CONCLUSION: High grade dysplasia is the most im-portant factor for predicting malignancy as a final pathologic diagnosis before treating the referred gastric adenoma. This discrepancy can occur mainly through inappropriately selecting a biopsy site where cancer cells do not exist, but it also depends on the pathologist to some extent.

Keywords: Discrepancy; Adenoma; High grade dysplasia; Endoscopic mucosal resection; Endoscopic submucosal dissection