Background: As biopsy sites may miss coexisting gastric mucosal high grade neoplasia (HGN) foci, making a diagnosis of gastric mucosal low grade neoplasia (LGN) based only on forceps biopsy specimens can be inaccurate. Therefore, to achieve an accurate diagnosis, endoscopic mucosal resection (EMR) of the entire lesion is required. However, EMR can cause serious complications such as perforation or bleeding. Considering these points, it is necessary to identify the characteristics suggesting coexisting HGN foci in cases initially diagnosed as LGN by forceps biopsy.
Methods: Three hundred and five lesions from 282 consecutive patients were initially diagnosed as LGN by forceps biopsy and later resected using EMR. The still photographs from endoscopies and pathology slides of these lesions were reviewed.
Results: After EMR, 272 lesions (89.2%) were finally diagnosed as LGN and 33 lesions (10.8%) were diagnosed as having HGN foci, including 1 intramucosal carcinoma. Univariate analysis showed that lesions >1.0 cm on endoscopy and lesions with tubulovillous or villous histology on forceps biopsy specimens were significantly more frequently found in cases with HGN than in LGN cases. Multivariate analysis demonstrated that lesion size >1.0 cm on endoscopy and findings of tubulovillous or villous histology on forceps biopsy specimens were independent risk factors for coexisting HGN foci in cases initially diagnosed as LGN by forceps biopsy.
Conclusions: If the lesions diagnosed as LGN by forceps biopsy are >1.0 cm on endoscopy or show tubulovillous or villous histology, EMR might be considered to avoid the risk of missing HGN foci.