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Abstract：
BACKGROUND: The pathological results obtained from endoscopic forceps biopsy (EFB) do not always align with the findings of postoperative endoscopic submucosal dissection (ESD). Furthermore, as ESD becomes more widespread, the number of noncurative endoscopic cases increases; thus, an accurate preoperative diagnosis and an appropriate treatment method are crucial. The purpose of this study was to explore the risk factors for postoperative pathological upgrading and noncurative resection and to gather experience in clinical and pathological diagnosis.
METHODS: From March 2016 to November 2023, 292 ESD specimens were collected from 262 patients with gastric mucosal lesions. Clinicopathological information, the coincidence rate of pathological diagnosis between EFB and ESD specimens, and risk factors related to noncurative resection were analyzed retrospectively.
RESULTS: The overall upgraded pathological diagnosis rate between EFB and ESD was 26.4%. The independent predictors for the upgraded group included proximal stomach lesions, lesion size > 2 cm, surface ulceration, and surface nodules. Twenty of the 235 early gastric cancer (EGC) patients underwent noncurative ESD resection. Multivariate analysis showed that undifferentiated carcinoma and tumor infiltration into the submucosa were significantly associated with noncurative resection.
CONCLUSIONS: Biopsy cannot fully represent the lesions of gastric intraepithelial neoplasia (GIN). When a suspected epithelial dysplasia is suspected, a careful endoscopic examination should be conducted to evaluate the lesion site, size, and surface characteristics to ensure an accurate diagnosis. Noncurative endoscopic resection is associated with undifferentiated carcinoma and submucosal infiltration. Clinicians must be familiar with these predictive factors for noncurative resection and select the appropriate treatment for their patients.
METHODS: From March 2016 to November 2023, 292 ESD specimens were collected from 262 patients with gastric mucosal lesions. Clinicopathological information, the coincidence rate of pathological diagnosis between EFB and ESD specimens, and risk factors related to noncurative resection were analyzed retrospectively.
RESULTS: The overall upgraded pathological diagnosis rate between EFB and ESD was 26.4%. The independent predictors for the upgraded group included proximal stomach lesions, lesion size > 2 cm, surface ulceration, and surface nodules. Twenty of the 235 early gastric cancer (EGC) patients underwent noncurative ESD resection. Multivariate analysis showed that undifferentiated carcinoma and tumor infiltration into the submucosa were significantly associated with noncurative resection.
CONCLUSIONS: Biopsy cannot fully represent the lesions of gastric intraepithelial neoplasia (GIN). When a suspected epithelial dysplasia is suspected, a careful endoscopic examination should be conducted to evaluate the lesion site, size, and surface characteristics to ensure an accurate diagnosis. Noncurative endoscopic resection is associated with undifferentiated carcinoma and submucosal infiltration. Clinicians must be familiar with these predictive factors for noncurative resection and select the appropriate treatment for their patients.
摘要：
背景：从内镜钳活检（EFB）获得的病理结果并不总是与术后内镜黏膜下剥离术（ESD）的结果一致。此外，随着ESD变得越来越普遍，非治愈性内镜病例数增加；因此，准确的术前诊断和适当的治疗方法至关重要。目的探讨术后病理升级和非治愈性切除的危险因素，积累临床和病理诊断经验。
方法：从2016年3月至2023年11月，从262例胃粘膜病变患者中收集292例ESD标本。临床病理资料,EFB与ESD标本的病理诊断符合率,回顾性分析与非治愈性切除相关的危险因素。
结果：EFB和ESD的总体病理诊断升级率为26.4%。升级组的独立预测因素包括近端胃部病变，病变大小>2厘米，表面溃疡,和表面结核。235例早期胃癌（EGC）患者中有20例接受了非治愈性ESD切除术。多因素分析表明，未分化癌和肿瘤浸润到粘膜下层与非治愈性切除显着相关。
结论：活检不能完全代表胃上皮内瘤变（GIN）的病变。当怀疑上皮发育不良时，应进行仔细的内窥镜检查以评估病变部位，尺寸,和表面特性，以确保准确的诊断。非治愈性内镜切除与未分化癌和粘膜下浸润有关。临床医生必须熟悉这些非治愈性切除的预测因素，并为患者选择合适的治疗方法。
方法：从2016年3月至2023年11月，从262例胃粘膜病变患者中收集292例ESD标本。临床病理资料,EFB与ESD标本的病理诊断符合率,回顾性分析与非治愈性切除相关的危险因素。
结果：EFB和ESD的总体病理诊断升级率为26.4%。升级组的独立预测因素包括近端胃部病变，病变大小>2厘米，表面溃疡,和表面结核。235例早期胃癌（EGC）患者中有20例接受了非治愈性ESD切除术。多因素分析表明，未分化癌和肿瘤浸润到粘膜下层与非治愈性切除显着相关。
结论：活检不能完全代表胃上皮内瘤变（GIN）的病变。当怀疑上皮发育不良时，应进行仔细的内窥镜检查以评估病变部位，尺寸,和表面特性，以确保准确的诊断。非治愈性内镜切除与未分化癌和粘膜下浸润有关。临床医生必须熟悉这些非治愈性切除的预测因素，并为患者选择合适的治疗方法。
