Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Clinical Pathology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.
PLoS One. 2023 Jan 25;18(1):e0280735. doi: 10.1371/journal.pone.0280735. eCollection 2023.
Lesions diagnosed as gastric low-grade dysplasia (LGD) may be pathologically upgraded to early gastric cancer (EGC) or high-grade dysplasia (HGD) after endoscopic resection (ER). In this study, we investigated the risk factors for pathological upgrades after ER and assessed the reason for these upgrades by retrospectively analyzing ER data between January 1999 and December 2019. We enrolled patients with LGD confirmed by forceps biopsy; the patients were classified into pathologically concordant (LGD) and upgraded (HGD and EGC) groups according to the pathology of their resected specimen. To determine the risk factors for upgrade, we compared the endoscopic findings of the concordant and upgraded groups via 1:1 matched case-control design. To find the reasons for discordance, all upgraded cases were pathologically re-evaluated. Among 1,643 cases of LGD, pathological upgrades were observed in 423 (25.7%) resected specimens and EGC was found in 111 (6.7%) lesions. After matching the upgraded and concordant cases, lesion sizes exceeding 1.5 cm (odds ratio (OR): 1.8; 95% CI: 1.1-3.0), mucosal nodularity (OR: 10.8; 95% CI: 5.6-21.0), heterogeneous color (OR: 3.0; 95% CI: 1.7-5.3), presence of erosion (OR: 2.7; 95% CI: 1.8-5.3), and open-type gastric atrophy (OR: 2.9; 95% CI: 1.7-4.9) were noted to be significantly associated with upgraded pathology to EGC. Among the EGC cases, 99 (89.2%) were found to have pre-existing dysplasia. In conclusion, endoscopic evaluations should be performed because of possible pathological upgrades and co-existence of carcinomas in LGDs, especially when they exhibit surface nodularity, erosion, heterogeneous color, and large size.
胃低级别上皮内瘤变（LGD）经内镜切除（ER）后可能会在病理上升级为早期胃癌（EGC）或高级别上皮内瘤变（HGD）。本研究通过回顾性分析 1999 年 1 月至 2019 年 12 月的 ER 数据，旨在探讨 ER 后病理升级的危险因素，并评估这些升级的原因。我们纳入了经活检证实为 LGD 的患者；根据切除标本的病理结果，将患者分为病理一致（LGD）和升级（HGD 和 EGC）组。为了确定升级的危险因素，我们通过 1:1 匹配病例对照设计比较了一致和升级组的内镜表现。为了找到不一致的原因，对所有升级病例进行了病理重新评估。在 1643 例 LGD 中，423 例（25.7%）切除标本出现病理升级，111 例（6.7%）病变发现 EGC。在匹配升级和一致病例后，发现病变大小超过 1.5cm（优势比（OR）：1.8；95%置信区间（CI）：1.1-3.0）、黏膜结节（OR：10.8；95%CI：5.6-21.0）、异质性颜色（OR：3.0；95%CI：1.7-5.3）、存在糜烂（OR：2.7；95%CI：1.8-5.3）和开放型胃萎缩（OR：2.9；95%CI：1.7-4.9）与升级为 EGC 的病理显著相关。在 EGC 病例中，发现 99 例（89.2%）存在先前存在的异型增生。总之，由于 LGD 可能出现病理升级和共存癌，特别是当它们表现出表面结节、糜烂、异质性颜色和大小时，应进行内镜评估。
