Ann Surg Oncol. 2013 Dec;20(13):4231-7. doi: 10.1245/s10434-013-3196-y.
Tumor differentiation is a major determinant of endoscopic resection in mucosal gastric cancers, and the treatment decision is usually based on a preoperative endoscopic biopsy. However, in a proportion of patients, the pathologic assessment of differentiation differs between the endoscopic biopsy and postgastrectomy specimen. This discrepancy is important in that it may lead to an additional radical gastrectomy after endoscopic resection or unnecessary operation for patients who could have been treated with endoscopic resection. This study aimed to investigate the frequency of such cases and to identify risk factors for discordance in patients with mucosal gastric adenocarcinoma.
The clinicopathologic characteristics of 1,326 patients who underwent curative gastrectomy for mucosal gastric cancer at Asan Medical Center from 2007 to 2011 were retrospectively reviewed.
The overall discordance was 21.5 % (285 cases), and clinically significant discordant rate was 11.9 % (157 cases). Ninety-nine tumors (7.5 %) with differentiated histology on preoperative biopsy were found to be undifferentiated on postoperative pathology. Additionally, 58 patients (4.4 %) with undifferentiated histology on preoperative biopsy exhibited differentiated histology postoperatively. Multivariate analysis revealed that age, sex, tumor location, size, and gross pattern were associated with overall pathologic discordance. In patients with clinically significant discordance, only tumor location (cardia) and size ([2 cm) were independent factors for discordance.
Considering a high discordance rate of differentiation between biopsy samples and resected specimens in mucosal cancer in cardia, performing endoscopic resection for confirmative diagnosis of differentiation before total gastrectomy can be a good option.
肿瘤分化是决定胃黏膜癌内镜切除的主要因素，治疗决策通常基于术前内镜活检。然而，在一部分患者中，内镜活检和胃切除标本的分化病理评估存在差异。这种差异很重要，因为它可能导致内镜切除后进行额外的根治性胃切除术，或者对可以通过内镜切除治疗的患者进行不必要的手术。本研究旨在调查这种病例的频率，并确定黏膜胃腺癌患者分化不一致的危险因素。
回顾性分析 2007 年至 2011 年在 Asan 医疗中心接受根治性胃切除术治疗黏膜胃腺癌的 1326 例患者的临床病理特征。
总体不一致率为 21.5%（285 例），临床显著不一致率为 11.9%（157 例）。99 例术前活检分化组织学的肿瘤在术后病理中被发现为未分化。此外，58 例术前活检为未分化组织学的患者术后表现为分化组织学。多因素分析显示，年龄、性别、肿瘤部位、大小和大体形态与总体病理不一致有关。在临床显著不一致的患者中，仅肿瘤部位（贲门）和大小（[2cm）是不一致的独立因素。
考虑到贲门黏膜癌活检样本与切除标本之间存在较高的分化差异率，在全胃切除术前对分化进行内镜确认诊断可能是一个不错的选择。
