Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea,
Surg Endosc. 2014 Jul;28(7):2097-105. doi: 10.1007/s00464-014-3441-x. Epub 2014 Feb 1.
Histologic discrepancies among specimens obtained by forceps biopsy and endoscopic resection (ER) between the differentiated and undifferentiated types often occur in early gastric cancer (EGC). This study aimed to evaluate the predictive clinicopathologic characteristics and clinical implications of histologic discrepancies in EGC.
From August 2005 to March 2012, 596 lesions from 579 patients underwent ER for EGC. The lesions studied were diagnosed as the differentiated histologic type from forceps biopsy specimens. The lesions were grouped according to the occurrence of histologic discrepancy between the differentiated and undifferentiated types in specimens obtained by ER as concordant (n = 570) or discordant (n = 26). The main outcome measures were en bloc resection, complete resection, and curative resection rates.
The histologic discrepancy rate was 4.4% among the studied lesions. Larger size, lesion location in the mid third of the stomach, easy friability, exudates, and submucosal invasion shown on endoscopic ultrasound were significantly related to histologic discrepancy in the univariate analysis. In the multivariate analysis, lesion location in the mid third of the stomach [odds ratio (OR) 5.34, 95% confidence interval (CI) 1.59-19.13] and easy friability (OR 29.26, 95% CI 2.30 to >999.9) were significant factors associated with histologic discrepancy. The complete resection and curative resection rates were significantly lower and the additional operation rates after ER were significantly higher in the discordant group.
The EGCs with histologic discrepancy between the differentiated and undifferentiated types changed the therapeutic outcomes of ER. Easily friable lesions located in the mid third of the stomach carry a significant risk for histologic discrepancy in undifferentiated histology when ER of EGCs is performed.
在早期胃癌（EGC）中，通过活检钳和内镜切除（ER）获得的标本在分化型和未分化型之间经常存在组织学差异。本研究旨在评估 EGC 中组织学差异的预测临床病理特征和临床意义。
从 2005 年 8 月至 2012 年 3 月，579 例患者的 596 处病变接受 ER 治疗 EGC。研究的病变从活检标本中被诊断为分化型组织学类型。根据 ER 获得的标本中分化型和未分化型之间组织学差异的发生情况，将病变分为一致（n=570）或不一致（n=26）两组。主要观察指标为整块切除率、完全切除率和根治性切除率。
研究病变的组织学差异率为 4.4%。较大的病变大小、胃中三分之一部位的病变位置、易脆、渗出物和内镜超声显示的黏膜下浸润在单因素分析中与组织学差异显著相关。在多因素分析中，胃中三分之一部位的病变位置[比值比（OR）5.34，95%置信区间（CI）1.59-19.13]和易脆[OR 29.26，95%CI 2.30-＞999.9]是与组织学差异相关的显著因素。不一致组的完全切除率和根治性切除率显著较低，ER 后附加手术率显著较高。
分化型和未分化型之间存在组织学差异的 EGC 改变了 ER 的治疗结果。在进行 EGC 的 ER 时，位于胃中三分之一部位且易脆的病变发生未分化组织学组织学差异的风险显著增加。
