Histologic Discrepancy between Gastric Biopsy and Resection Specimen in the Era of Endoscopic Treatment for Early Gastric Cancer

Mee Joo; Kyoung-Mee Kim

doi:10.4166/kjg.2014.64.5.256

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Joo and Kim: Histologic Discrepancy between Gastric Biopsy and Resection Specimen in the Era of Endoscopic Treatment for Early Gastric Cancer

Review Article

Korean J Gastroenterol 2014;64(5):256-259.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.64.5.256

Histologic Discrepancy between Gastric Biopsy and Resection Specimen in the Era of Endoscopic Treatment for Early Gastric Cancer

Mee Joo, Kyoung-Mee Kim¹

Department of Pathology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

¹Department of Pathology, Samsung Seoul Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Kyoung-Mee Kim, Department of Pathology & Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-2768, Fax: +82-2-3410-6396, E-mail: kkmkys@skku.edu

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.

Abstract

Endoscopic resection (ER) is accepted as a treatment option for early gastric cancer in patients with negligible risk of lymph node metastasis. Determination of histologic differentiation of adenocarcinoma based on pretreatment endoscopic biopsy is critical in deciding the treatment strategy of ER versus surgical resection. However, discrepancies are frequent between pretreatment biopsies and ER specimens, which may result in an additional gastrectomy after ER. In this context, a review on possible factors contributing to the diagnostic discrepancy in the histologic difference between the pretreatment biopsy and ER is necessary. Two major factors are significantly associated with this discrepancy: pathologic characteristics of the tumor itself, i.e. histologic heterogeneity (tumor factor), and diagnostic procedure performed by endoscopists or pathologists (human factor). In this review, we focus on pathologic report of pretreatment biopsy specimens and its clinical significance.

Keywords: Stomach, Biopsy, Resection, Pathology, Endoscopy

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Fig. 1.

Representative microphotographs (H&E, ×200). (A) Pure differentiated type consisting of well differentiated tubular adenocarcinoma without any undifferentiated type components. (B) Differentiated-predominant mixed type showing a predominance of well differentiated tubular adenocarcinoma with a small area of poorly cohesive carcinoma in the deeper portion. (C) Undifferentiated-predominant mixed type showing a predominance of poorly cohesive carcinoma with less than 50% of well to moderately differentiated adenocarcinoma. (D) Pure undifferentiated type consisting of undifferentiated type components only.

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