Korean J Gastroenterol.  2014 Nov;64(5):256-259. 10.4166/kjg.2014.64.5.256.

Histologic Discrepancy between Gastric Biopsy and Resection Specimen in the Era of Endoscopic Treatment for Early Gastric Cancer

• Joo M
• Kim KM

• KMID: 2164427
• DOI: http://doi.org/10.4166/kjg.2014.64.5.256

Abstract

Endoscopic resection (ER) is accepted as a treatment option for early gastric cancer in patients with negligible risk of lymph node metastasis. Determination of histologic differentiation of adenocarcinoma based on pretreatment endoscopic biopsy is critical in deciding the treatment strategy of ER versus surgical resection. However, discrepancies are frequent between pretreatment biopsies and ER specimens, which may result in an additional gastrectomy after ER. In this context, a review on possible factors contributing to the diagnostic discrepancy in the histologic difference between the pretreatment biopsy and ER is necessary. Two major factors are significantly associated with this discrepancy: pathologic characteristics of the tumor itself, i.e. histologic heterogeneity (tumor factor), and diagnostic procedure performed by endoscopists or pathologists (human factor). In this review, we focus on pathologic report of pretreatment biopsy specimens and its clinical significance.

Keyword

Stomach; Biopsy; Resection; Pathology; Endoscopy

MeSH Terms

Adenocarcinoma/*pathology
Biopsy
Cell Differentiation
Gastrectomy
Gastric Mucosa/pathology
Gastroscopy
Humans
Stomach Neoplasms/*pathology

Figure

• 

  Fig. 1. Representative microphotographs (H&E, ×200). (A) Pure differentiated type consisting of well differentiated tubular adenocarcinoma without any undifferentiated type components. (B) Differentiated-predominant mixed type showing a predominance of well differentiated tubular adenocarcinoma with a small area of poorly cohesive carcinoma in the deeper portion. (C) Undifferentiated-predominant mixed type showing a predominance of poorly cohesive carcinoma with less than 50% of well to moderately differentiated adenocarcinoma. (D) Pure undifferentiated type consisting of undifferentiated type components only.

Reference

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