Diagnostic Value of Endoscopic Mucosal Resection in Low Grade Dysplasia of Gastric Mucosa

Abstract

Background: The high grade dysplasia has been regarded as a premalignant lesion because of 75% - 100% of malignant transformation rate within two years. Therefore, surgery or endoscopic therapy is recommended to treat the high grade dysplasia. On the other hand, it has been reported that low grade dysplasia has relative low risk of malignant transformation. But various histologic grades might be presented at single dysplastic lesion and so the endoscopic forceps biopsy could not represent whole pathologic lesion. Thus we evaluate the histologic discrepancy between forceps biopsy and the endoscopic mucosal resection in patients with low grade dysplasia. Methods: We reviewed retrospectively 142 cases (M:F = 84:58) undergone endoscopic mucosal resection after diagnosed as low grade dysplasia by endoscopic forceps biopsy from 1998 to 2005. Results: The mean age of patients was 62.6 ± 8.8 (28-77 years) years old . Of the 142 patients, the pathologic results through the endoscopic mucosal resection showed 7 cases (4.9%) of adenocarcinoma, 15 cases (10.6%) of high grade dysplasia, 102 cases (71.8%) low grade dysplasia, 4 cases (2.8%) of hyperplastic polyp, 14 case (9.9%) of chronic gastritis. Twenty two cases (15.5%) among 142 cases were upgraded in the histologic staging to carcinoma or high grade dysplasia. Conclusion: Although low grade dysplasia was diagnosed initially by endoscopic forceps biopsy, endoscopic mucosal resection was need to confirm accurate diagnosis and treat at once. Because focal high grade dysplasia or adenocarcinoma can be existed around low grade dysplasia lesion.