Soh JS, Lim H, Kang HS, Kim JH, Kim KC. Does the discrepancy in histologic differentiation between a forceps biopsy and an endoscopic specimen necessitate additional surgery in early gastric cancer? World J Gastrointest Oncol 2017; 9(8): 319-326 [PMID: PMC5561043 DOI: 10.4251/wjgo.v9.i8.319]
Corresponding Author of This Article
Kab Choong Kim, MD, PhD, Department of Surgery, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang 14068, South Korea. stonebody@hallym.or.kr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Aug 15, 2017; 9(8): 319-326 Published online Aug 15, 2017. doi: 10.4251/wjgo.v9.i8.319
Does the discrepancy in histologic differentiation between a forceps biopsy and an endoscopic specimen necessitate additional surgery in early gastric cancer?
Jae Seung Soh, Hyun Lim, Ho Suk Kang, Jong Hyeok Kim, Kab Choong Kim
Jae Seung Soh, Hyun Lim, Ho Suk Kang, Jong Hyeok Kim, Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, South Korea
Kab Choong Kim, Department of Surgery, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, South Korea
Author contributions: Soh JS and Kim KC designed the research; Soh JS, Lim H, Kang HS, Kim JH and Kim KC performed the research; Soh JS and Kim KC collected and analyzed data; Soh JS and Lim H performed the literature review; Soh JS wrote the manuscript; Kim KC supervised the review.
Institutional review board statement: The study was reviewed and approved by the local ethics committee at Hallym Sacred Heart Medical Center (IRB 2016-I129).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kab Choong Kim, MD, PhD, Department of Surgery, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang 14068, South Korea. stonebody@hallym.or.kr
Telephone: +82-31-3803710 Fax: +82-31-3803772
Received: March 24, 2017 Peer-review started: March 29, 2017 First decision: May 5, 2017 Revised: May 9, 2017 Accepted: June 6, 2017 Article in press: June 7, 2017 Published online: August 15, 2017 Processing time: 139 Days and 6.2 Hours
Abstract
AIM
To investigate the clinicopathological variables in early gastric cancer (EGC) patients in relation to differentiation discrepancy.
METHODS
The data of 265 specimens from 240 patients with EGC, who had undergone radical operation at Hallym University Sacred Heart Hospital from 2010 to 2015, were retrospectively analyzed. We evaluated clinical, endoscopic, and histopathological data according to histological discrepancy.
RESULTS
Clinically significant discrepancy rate showed the difference in differentiated type (well and moderately differentiated) and undifferentiated type (poorly differentiated and signet ring cell) between endoscopic biopsies and postoperative specimens was 9.4% (25/265). There were no differences in tumor location, size, gross pattern, and number of biopsies. Specimens having histological discrepancy showed more submucosal invasion (72.0% vs 49.6%, P = 0.033) and lymph node involvement (24.0% vs 7.9%, P = 0.009) than specimens having non-discrepancy. The rate of a positive epidermal growth factor receptor status was higher in specimens having discrepancy than in specimens having non-discrepancy (81.0% vs 55.4%, P = 0.035).
CONCLUSION
The discordance of histologic differentiation is associated with higher submucosal invasion and lymph node metastases in EGC. Patients have histological discrepancy may require additional surgical treatments.
Core tip: The discordance of differentiation between forceps biopsies and endoscopically resected specimens may necessitate a radical gastrectomy and predict poor outcomes. We analyzed clinicopathological variables of early gastric cancer patients in relation to differentiation discrepancy. Clinically significant discrepancy rate between endoscopic biopsies and postoperative specimens was 9.4%. Specimens having histological discrepancy showed more submucosal invasion and lymph node metastases than specimens having non-discrepancy. Patients who have histological discrepancy detected in endoscopically resected specimens may require additional surgical treatments.
