Zhongguo quanke yixue (Sep 2023)
Related Factors of Pathological Upgrading in Gastric Mucosal Lesions after Endoscopic Submucosal Dissection
Abstract
Background Early diagnosis of gastric cancer is essential for patient prognosis. Currently, endoscopic forceps biopsy (EFB) is an important tool for the diagnosis of gastric cancer. However, it has been shown in relevant studies that there are some differences between EFB-based diagnosis and pathological diagnosis after endoscopic submucosal dissection (ESD), resulting in an underestimation of the patient's condition. No related research has been conducted in northern Shaanxi. Objective To calculate the rate of pathological upgrading in gastric mucosal lesions after ESD in five hospitals in northern Shaanxi, and to analyze the factors associated with pathological upgrading. Methods We recruited patients with gastric mucosal lesions who underwent ESD following EFB in five hospitals (Yan'an University Affiliated Hospital, Yan'an People's Hospital, the First Hospital of Yulin, Yan'an Traditional Chinese Medicine Hospital, Zichang People's Hospital) from 2016 to 2021. We classified the pathological results of gastric mucosal lesions into the following categories: chronic gastric inflammatory changes (CIC), low-grade gastric intraepithelial neoplasia (LGIN), high-grade gastric intraepithelial neoplasia (HGIN), early gastric cancer (EGC) and progressive gastric cancer. The difference between EFB-based diagnosis and pathological diagnosis of ESD specimens was analyzed. Pathological upgrading was defined as progression in pathological results. The pathological upgrading in patients with CIC, LGIN or HGIN was counted. The factors associated with pathological upgrading were analyzed. Results A total of 241 patients were included. The EFB-based diagnosis of CIC, LGIN, HGIN, and EGC were 84, 75, 65, 17 cases, respectively. Seventy-six (31.5%) were found with pathological upgrading after ESD compared with their EFB-based diagnoses. Binary logistic regression analysis showed that endoscopic classification〔OR=0.134, 95%CI (0.029, 0.617) 〕 and superficial ulceration〔OR=3.595, 95%CI (1.226, 10.536) 〕 were associated with pathological upgrading in CIC by EFB-based diagnosis (P<0.05). Age〔OR=3.961, 95%CI (1.071, 14.650) 〕, endoscopic classification〔OR=0.311, 95%CI (0.127, 0.765) 〕, redness of mucosal surface〔OR=5.830, 95%CI (1.591, 21.355) 〕, and number of specimens〔OR=0.234, 95%CI (0.063, 0.872) 〕 were associated with pathological upgrading in LGIN by EFB-based diagnosis (P<0.05). Lesion size〔OR=3.143, 95%CI (1.003, 9.852) 〕 was associated with pathological upgrading in HGIN by EFB-based diagnosis (P<0.05) . Conclusion Medical workers should be alert to the potential possibility of underestimated pathology in EFB if the lesion is CIC suggested by EFB but is endoscopically classified as flat or concave with surface ulceration. And the potential possibility is also should be considered if there is only one biopsy specimen obtained from a patient aged greater than 60 years, and the lesion is LGIN suggested by EFB, but is endoscopically classified as flat with redness of mucosal surface, and an ESD can be underwent if necessary. Moreover, if a lesion greater than 2 cm in size is HGIN suggested by EFB, which is probably EGC, and an ESD is recommended to verify it.
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