Discussion on pathological differences between preoperative biopsy and postoperative pathology of endoscopic submucosal dissection for gastric intraepithelial neoplasia

Abstract

Objective To investigate the pathological differences between preoperative biopsy and postoperative pathology of ESDfor gastric mucosal intraepithelial neoplasia, and analyze the differences and related influencing factors. Methods This study retrospectively analyzed the data of 342 patients who received ESD treatment and were diagnosed as LGIN/HGIN by white light-gastroscopy biopsy in Jiangsu Provincial Hospital of Chinese Medicine from July 2016 to June 2019.Statistical methods were used to analyze the influencing factors leading to the difference. Results Among the 342 patients, 187 were diagnosed with LGIN, 155 were diagnosed with HGIN.In the LGIN group, 61.5% remain the same, 21.4% upgraded to HGIN and 12.8% upgraded to early or advanced gastric cancer. The total upgrade rate of LGIN was 34.2%, and the downgrade rate of chronic inflammation was 4.3%.In the HGIN group, 40.6% remain the same, 52.9%(82/155)upgraded to early or advenced gastric cancer, 6.5%(10/155)downgraded to LGIN. Results of multivariate regression analysis showed that lesions located in the upper 1/3 of the stomach, accompanied by surface hyperemia, surface nodule, DL(+ ), MV(+ )were risk factors for pathological upgrading in LGIN group.Surface nodule was the risk factor for pathological upgrading of HGIN. Conclusions There are differences between preoperative biopsy pathology under white light endoscopy and postoperative pathology, lesions in the upper 1/3 of the stomach, accompanied by surface hyperemia, surface nodular, DL(+ ), MV(+ )were the risk factors for pathological upgrading of LGIN group.Surface nodule was the risk factor for pathological upgrading of HGIN. Key words: Gastric intraepithelial neoplasia; Biopsy; Endoscopic submucosal dissection; Pathological difference