Reliability of endoscopic biopsy compared with endoscopic submucosal dissection histopathologic diagnosis.

Abstract

15 Background: Endoscopic biopsy is the most convenient and simple method for approaching gastric neoplasm. Aim of our study was to determine the diagnostic accuracy of biopsy during screening endoscopy compared to endoscopic submucosal dissection (ESD). Methods: 175 patients who underwent both screening endoscopic biopsy and ESD from 2015.01 to 2017.12 in Bucheon St. Mary’s hospital were retrospectively reviewed. Results: Seventeen lesions had different histopathological ESD findings compared with endoscopic biopsy. Among six endoscopic biopsies that showed atypia, four were diagnosed with adenocarcinoma and two maintained the results. 64 out of the 175 lesions showed low grade dysplasia by endoscopic biopsy. After ESD, two cases were diagnosed with high grade dysplasia and two cases were diagnosed with adenocarcinoma. Of 12 lesions which showed high grade dysplasia on endoscopic biopsy, four lesions turned out to be adenocarcinoma (three well differentiated, one moderately differentiated) after ESD. Of 91 adenocarcinoma lesions on endoscopic biopsy, three lesions had discrepancy on differentiation level and one lesion turned out to be signet ring cell carcinoma after all. Patients who were infected with Helicobacter pylori (H. pylori) had tendency to have discrepancy between initial biopsy and ESD histopathology result. (OR 3.68, 95% CI 1.08-11.955, P = 0.018). Conclusions: Discrepancy between endoscopic biopsy and post-ESD histopathology were found. Possibility of coexistence or progression to high grade neoplasm should be considered regarding endoscopic biopsy results especially if infected with H. pylori and active ESD histopathological confirmation needs to be done if necessary.