Endoscopic resection for gastric epithelial neoplasia: How to solve pathological discrepancy and achieve curative resection?

Endoscopic resection (ER) was introduced to China from Japan, while most pathologists are influenced by Western criteria. Japanese and Western pathologists have debated for decades how best to distinguish between gastric intraepithelial neoplasia (GIEN) and early gastric cancer (EGC). In this study we aimed to find out how to solve this pathological discrepancy and improve the curative resection of lesions based on our experiences.In total, 143 patients with GIEN or EGC were treated by ER in our hospital from April 2008 to April 2012. The risk factors related to the degree of malignancy of the lesions and the non-curability of ER were analyzed. Pathological discrepancy between forceps biopsies and ER specimens was also compared.According to the histological types of the ER specimens, there were 67 patients with low-grade intraepithelial neoplasia (LGIN), 35 with high-grade intraepithelial neoplasia (HGIN) and 41 with EGC. The ER histological type was significantly correlated with gender, ER method, macroscopic type, tumor size, ulcer and histological type of the forceps biopsy (P < 0.05). The discrepancy between forceps biopsy and ER specimens was 41.3% (59/143). Furthermore, the depth of tumor invasion and ER histological type were associated with the curative resection of HGIN and EGC (P < 0.05).The pathological discrepancy shows that patients with HGIN in forceps biopsy should be considered candidates for ER. The risk factors of lesion malignancy and ER curability indicate the great importance of pretreatment evaluation for ER.