Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nan Men Cang, Dong Cheng District, Beijing, 100700, China.
Surg Endosc. 2023 Jun;37(6):4737-4747. doi: 10.1007/s00464-023-09968-x. Epub 2023 Mar 8.
The natural course of gastric low-grade dysplasia (LGD) remains unclear, and there are inconsistent management recommendations among guidelines and consensus.
This study aimed to investigate the incidence of advanced neoplasia in patients with gastric LGD and identify the related risk factors.
Cases of biopsy demonstrated LGD (BD-LGD) at our center from 2010 to 2021 were reviewed retrospectively. Risk factors related to histological progression were identified, and outcomes of patients based on risk stratification were evaluated.
Ninety-seven (23.0%) of 421 included BD-LGD lesions were diagnosed as advanced neoplasia. Among 409 superficial BD-LGD lesions, lesion in the upper third of the stomach, H. pylori infection, larger size, and narrow band imaging (NBI)-positive findings were independent risk factors of progression. NBI-positive lesions and NBI-negative lesions with or without other risk factors had 44.7%, 1.7%, and 0.0% risk of advanced neoplasia, respectively. Invisible lesions, visible lesions (VLs) without a clear margin, and VLs with a clear margin and size ≤ 10 mm, or > 10 mm had 4.8%, 7.9%, 16.7%, and 55.7% risk of advanced neoplasia, respectively. In addition, endoscopic resection decreased the risk of cancer (P < 0.001) and advanced neoplasia (P < 0.001) in patients with NBI-positive lesions, but not in NBI-negative patients. Similar results were found in patients with VLs with clear margin and size > 10 mm. Moreover, NBI-positive lesions had higher sensitivity and lower specificity for predicting advanced neoplasia than VLs with a clear margin and size > 10 mm determined by white-light endoscopy (97.6% vs. 62.7%, P < 0.001; and 63.0% vs. 85.6%, P < 0.001, respectively).
Progression of superficial BD-LGD is associated with NBI-positive lesions, as well as with VLs with a clear margin (size > 10 mm) if NBI is unavailable, and selective resection of those lesions offers benefits for patients by decreasing the risk of advanced neoplasia.
胃低级别上皮内瘤变（LGD）的自然病程尚不清楚，指南和共识中的管理建议也不一致。
本研究旨在探讨胃 LGD 患者中高级别肿瘤的发生率，并确定相关的危险因素。
回顾性分析 2010 年至 2021 年我院活检证实为 LGD（BD-LGD）的病例。确定与组织学进展相关的危险因素，并根据风险分层评估患者的结局。
421 例 BD-LGD 病变中，97 例（23.0%）诊断为高级别肿瘤。在 409 例胃黏膜浅层 BD-LGD 病变中，胃上部病变、幽门螺杆菌感染、病变较大、窄带成像（NBI）阳性是进展的独立危险因素。NBI 阳性病变和无 NBI 阳性表现但有或无其他危险因素的病变高级别肿瘤的风险分别为 44.7%、1.7%和 0.0%。不可见病变、边界不清的可见病变（VLs）和边界清楚且直径≤10mm 或＞10mm 的 VLs 的高级别肿瘤风险分别为 4.8%、7.9%、16.7%和 55.7%。此外，NBI 阳性病变患者行内镜下切除可降低癌症（P＜0.001）和高级别肿瘤（P＜0.001）的风险，但 NBI 阴性患者无此获益。在边界清楚且直径＞10mm 的 VLs 患者中也观察到了相似的结果。此外，与白光内镜下边界清楚且直径＞10mm 的 VLs 相比，NBI 阳性病变对高级别肿瘤的预测具有更高的敏感性和更低的特异性（97.6%比 62.7%，P＜0.001；63.0%比 85.6%，P＜0.001）。
胃黏膜浅层 BD-LGD 的进展与 NBI 阳性病变有关，如 NBI 不可用，还与边界清楚（直径＞10mm）的 VLs 有关，选择性切除这些病变可降低高级别肿瘤的风险，从而使患者获益。
