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Clinicopathologic factors and outcomes of histologic discrepancy between differentiated and undifferentiated types after endoscopic resection of early gastric cancer

Authors
 Choong Nam Shim  ;  Hyunki Kim  ;  Dong Wook Kim  ;  Hyun Soo Chung  ;  Jun Chul Park  ;  Hyuk Lee  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Yong Chan Lee 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.28(7) : 2097-2105, 2014 
Journal Title
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 
ISSN
 0930-2794 
Issue Date
2014
MeSH
Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Adult ; Aged ; Biopsy/methods ; Carcinoma, Signet Ring Cell/pathology ; Carcinoma, Signet Ring Cell/surgery ; Female ; Gastric Mucosa/pathology ; Gastroscopy* ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Patient Outcome Assessment* ; Reoperation ; Retrospective Studies ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/surgery
Keywords
Early gastric cancer ; Endoscopic resection ; Histology ; Discrepancy
Abstract
BACKGROUND: Histologic discrepancies among specimens obtained by forceps biopsy and endoscopic resection (ER) between the differentiated and undifferentiated types often occur in early gastric cancer (EGC). This study aimed to evaluate the predictive clinicopathologic characteristics and clinical implications of histologic discrepancies in EGC. METHODS: From August 2005 to March 2012, 596 lesions from 579 patients underwent ER for EGC. The lesions studied were diagnosed as the differentiated histologic type from forceps biopsy specimens. The lesions were grouped according to the occurrence of histologic discrepancy between the differentiated and undifferentiated types in specimens obtained by ER as concordant (n = 570) or discordant (n = 26). The main outcome measures were en bloc resection, complete resection, and curative resection rates. RESULTS: The histologic discrepancy rate was 4.4% among the studied lesions. Larger size, lesion location in the mid third of the stomach, easy friability, exudates, and submucosal invasion shown on endoscopic ultrasound were significantly related to histologic discrepancy in the univariate analysis. In the multivariate analysis, lesion location in the mid third of the stomach [odds ratio (OR) 5.34, 95% confidence interval (CI) 1.59-19.13] and easy friability (OR 29.26, 95% CI 2.30 to >999.9) were significant factors associated with histologic discrepancy. The complete resection and curative resection rates were significantly lower and the additional operation rates after ER were significantly higher in the discordant group. CONCLUSIONS: The EGCs with histologic discrepancy between the differentiated and undifferentiated types changed the therapeutic outcomes of ER. Easily friable lesions located in the mid third of the stomach carry a significant risk for histologic discrepancy in undifferentiated histology when ER of EGCs is performed.
Full Text
http://link.springer.com/article/10.1007%2Fs00464-014-3441-x
DOI
10.1007/s00464-014-3441-x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyunki(김현기) ORCID logo https://orcid.org/0000-0003-2292-5584
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Shim, Choong Nam(심충남)
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lee, Hyuk(이혁)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99342
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