Accuracy And Risk Factors Of Estimation Of Endoscopic Biopsy For Neoplasia Lesions

Background and study aims Endoscopic biopsy is the most important means of diagnosis of gastric intraepithelial neoplasia(GIEN) and early gastric cancer(EGC). The treatment of the majority of GIEN and EGC are based on the pathologic diagnosis of endoscopic biopsy specimens. However, some discrepancies may occur between pathologic diagnoses of endoscopic biopsy specimens versus endoscopic resection(ER) specimens. The aim of our study is to investigate the value of preoperative endoscopic biopsy in the treatment of GIEN and EGC by ER and to analyze the risk factors which relate to the accuracy of endoscopic biopsy.Methods Clinical data of351patients who had a treatment of GIEN and EGC by ER in our department from november2002to november2011were retrospectively analyzed. Of the351patients, we studied289patients, including299lesions, who were diagnosed with GIEN or EGC by preoperative biopsy, with trying to investigate the concordance rate and the discrepancy rate of pathological features between endoscopic biopsy specimens and ER specimens of this299cases and find the possible causes of the discrepancy.Results The total concordance rate of GIEN or EGC identified by both endoscopic biopsy and postoperative pathology was94.0%(281/299). The full concordance rate of pathological diagnoses between preoperative biopsies and ER specimens was53.8%(161/299), including107cases of IEN and54early cancers. The full concordance rate was significantly higher in EGC than in the IEN[46.5%(107/230) VS78.3%(54/69), P<0.05]. There were29.4%(88/299) of cases whose pathological diagnoses after ER were more severe than biopsy, including24cases(22.4%,24/107) of HGIEN and16cases(15.0%,16/107)) of early cancer from LGIEN, and48cases of early cancer from HGIEN(39.0%,48/123). There were10.7%(32/299) of patients whose final pathological diagnoses were milder than biopsy, including20cases(16.3%,20/123) of LGIEN from HGIEN,10cases(14.5%,10/69) of HGIEN and2cases(2.9%,2/69) of LGIEN from EGC, and6.0%(18/199) of patients whose final diagnoses were gastritis. Univariate and multivariate analysis revealed that the size of lesion(P=0.018, odds ratiol.961,95%C11.125-3.417) and endoscopic biopsy without the guiding of NBI(P=0.004,odds ratio3.600,95%Cl1.498-8.650) were two risk factors which were significantly associated with the accuracy of endoscopic biopsy for GIEN.Conclusion We should be cautious when deal with biopsy for larger neoplasia lesions. With the guiding of NBI, the accuracy rate of endoscopic biopsy for GIEN can be improved remarkably. The pathological diagnosis by preoperative biopsy specimen is insufficient for representative of the nature of the gastric mucosal lesion at present, but it can give good suggestion for resecting gastric mucosal lesion by ER, and for some patients, endoscopic biopsy may also play a role for treatment. However, a lot of works remain to be done to select biopsy specimen in the most severe lesion accurately.