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Kim, Kim, Kim, Ryu, Ryu, Lee, Jeon, Choi, and Kim: Pathological differences between forceps biopsy specimens and endoscopic resection specimens in early gastric cancer patients
Original Article

Kosin Medical Journal 2014;29(2):117-124.

Published online: 18 December 2014

DOI: https://doi.org/10.7180/kmj.2014.29.2.117

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

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 20 August 201321 November 2013       Accepted 16 December 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.

Abstract

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.

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.

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.

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.

Keywords: Differences, Early gastric cancer, Endoscopic resection, Forcep biopsy, Histologic

REFERENCES

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Table 1.
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)

CIS, carcinoma in situ: WD, well differentiated; MD, moderate differentiated; PD. poorly differentiated;

EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection.

Table 2.
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

CIS, carcinoma in situ; WD, well differentiated; MD, moderate differentiated; PD, poorly differentiated.

Table 3.
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%)  
Table 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%)  

PD, poorly differentiated

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