J Korean Med Sci.  2012 Jan;27(1):36-39. 10.3346/jkms.2012.27.1.36.

Optimal Number of Endoscopic Biopsies in Diagnosis of Advanced Gastric and Colorectal Cancer

• Choi Y
• Choi HS
• Jeon WK
• Kim BI
• Park DI
• Cho YK
• Kim HJ
• Park JH
• Sohn CI

• KMID: 1792976
• DOI: http://doi.org/10.3346/jkms.2012.27.1.36

Abstract

Endoscopic biopsy is necessary to confirm a histopathologic diagnosis. Currently, 6 to 8 biopsies are recommended for diagnosis of a suspected malignant lesion. However, multiple biopsies may result in several problems, such as an increased risk of bleeding, procedure prolongation, and increased workload to pathologists. The aim of this study was to clarify the optimal number of endoscopic biopsy specimens required in diagnosis of advanced gastrointestinal cancer. Patients who were diagnosed with advanced gastrointestinal cancer during endoscopy were included. Five specimens were obtained sequentially from viable tissue of the cancer margin. Experienced pathologists evaluated each specimen and provided diagnoses. A total of 91 patients were enrolled. Fifty-nine subjects had advanced gastric cancer, and 32 had advanced colon cancer. Positive diagnosis rates of the first, second, and third advanced gastric cancer specimens were 81.3%, 94.9%, and 98.3%, respectively, while positive diagnosis rates of advanced colon cancer specimens were 78.1%, 87.5%, and 93.8%. Further biopsies did not increase positive diagnosis cumulative rates. This study demonstrated that three specimens were sufficient to make correct pathologic diagnoses in advanced gastrointestinal cancer. Therefore, we recommend 3 or 4 biopsies from viable tissue in advanced gastrointestinal cancer to make a pathologic diagnosis during endoscopy.

Keyword

Endoscopy, Gastrointestinal; Biopsy; Stomach Neoplasms; Colonic Neoplasms

MeSH Terms

Adult
Aged
Biopsy/*statistics & numerical data
Colorectal Neoplasms/*diagnosis/pathology
*Endoscopy, Digestive System
Female
Humans
Male
Middle Aged
Stomach Neoplasms/*diagnosis/pathology

Figure

• 

  Fig. 1 Cumulative diagnostic yield according to the order of endoscopic biopsy specimens in advanced gastric cancer and colon cancer.

Reference

1. Schapiro M, Auslander MO, Schapiro MB. The electronic video endoscope: clinical experience with 1200 diagnostic and therapeutic cases in the community hospital. Gastrointest Endosc. 1987. 33:63–68.

2. Sivak MV Jr, Fleischer DE. Colonoscopy with a VideoEndoscope: preliminary experience. Gastrointest Endosc. 1984. 30:1–5.

3. Tatsuta M, Iishi H, Okuda S, Oshima A, Taniguchi H. Prospective evaluation of diagnostic accuracy of gastrofiberscopic biopsy in diagnosis of gastric cancer. Cancer. 1989. 63:1415–1420.

4. Sancho-Poch FJ, Balanzó J, Ocaña J, Presa E, Sala-Cladera E, Cussó X, Vilardell F. An evaluation of gastric biopsy in the diagnosis of gastric cancer. Gastrointest Endosc. 1978. 24:281–282.

5. Hatfield AR, Slavin G, Segal AW, Levi AJ. Importance of the site of endoscopic gastric biopsy in ulcerating lesions of the stomach. Gut. 1975. 16:884–886.

6. Lal N, Bhasin DK, Malik AK, Gupta NM, Singh K, Mehta SK. Optimal number of biopsy specimens in the diagnosis of carcinoma of the oesophagus. Gut. 1992. 33:724–726.

7. Misumi A, Mori K, Ikeda T, Misumi K, Ookubo F, Shimamoto M, Nakashima K, Fujishima K, Yagi Y, Takano S, Shiraishi Y, Akagi M. Evaluation of fibergastroscopic biopsy in the diagnosis of gastric cancer: a study of 339 cases. Gastroenterol Jpn. 1978. 13:255–263.

8. Dekker W, Tytgat GN. Diagnostic accuracy of fiberendoscopy in the detection of upper intestinal malignancy. A follow-up analysis. Gastroenterology. 1977. 73:710–714.

9. Yalamarthi S, Witherspoon P, McCole D, Auld CD. Missed diagnoses in patients with upper gastrointestinal cancers. Endoscopy. 2004. 36:874–879.

10. Weiss JB, Gang MJ, Ekkers TJ, Gaetz HP, McCray RS. Direct vision gastric biopsy using the Machida FGS-B6 gastroscope. Gastrointest Endosc. 1970. 17:23–27.