Endoscopic mucosal resection is advocated for the treatment of early gastroesophageal neoplasms.
This technique has also been alluded to represent a superior diagnostic and staging modality.
Dr Mindy Hull and colleagues assessed the diagnostic concordance of preceding biopsies.
The research team compared the biopsies with endoscopic mucosal resection in 31 gastric and 10 esophageal specimens.
The specimens consisted of 6 low-grade and 12 high-grade dysplasias, 21 intramucosal adenocarcinomas, and 2 submucosal invasive adenocarcinomas.
Discrepancies were considered as either major or minor if the histologic grades differed by 2 or more, or by only 1, respectively.
|16 out of 41 cases had discrepant diagnoses|
|American Journal of Surgical Pathology|
The team compared discrepant and concordant cases with regard to the size of lesion, number of biopsy fragments, and extent of biopsy sampling.
These same variables were used to evaluate the differences seen between gastric and esophageal cases.
The team found that out of 41 cases, 16 had discrepant diagnoses, including 14 gastric and 2 esophageal neoplasms.
The researchers noted a major discrepancy in 1 of the gastric cases, and observed a minor discrepancy in 15 cases.
All but 2 of the discrepant cases were found to have a higher grade on endoscopic mucosal resection.
The team found that the average number of biopsy fragments was 4 in both concordant and discrepant groups.
The maximal dimension, surface area, and biopsy sampling ratios of the lesion were significantly greater in the discrepant cases than in the concordant cases.
In addition, the team observed a tendency of the esophageal cases to have a smaller size and a significantly extensive biopsy sampling.
Dr Hull's team concluded, “Endoscopic mucosal resection is superior to biopsy for diagnosing superficial gastroesophageal tumors.”
“Discrepancies between the specimens occur in larger lesions of more than 10 mm in size, and with less extensive biopsy sampling.”
“Endoscopic mucosal resection can substantially modify the diagnostic grade of a lesion and therefore facilitate optimal therapeutic decisions by avoiding undertreatment and overtreatment based on inaccurate grading and staging.”