Poorly differentiated component in gastric pinch biopsies predicts submucosal invasion

Diagnostic Pathology

Gregory Y Lauwers⁴  Jae J Kim²  Jong Chul Rhee²  Seonwoo Kim¹  Jun Haeng Lee²  Byung-Hoon Min²  Soomin Ahn⁵  Cheol Keun Park⁵  Kyoung-Mee Kim⁵  Mee Joo⁶  Sun Yang²  Sun-Mi Lee³ 

[1] Biostatistics Unit, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea;Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea;Department of Pathology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA;Department of Pathology, Massachusetts General Hospital, Boston, MA, USA;Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea;Department of Pathology, Ilsan Paik Hospital, College of Medicine, Inje University, Daewha-Dong, Ilsan-Gu, Goyang-Si, Gyeonggi-Do, Korea

关键词: Endoscopic resection;    Invasion;    Submucosa;    Histologic;    Biopsy;    Gastric cancer;   

Others  :  803020
DOI  :  10.1186/1746-1596-9-34

 received in 2013-07-09, accepted in 2013-12-03,  发布年份 2014

【 摘 要 】

Background

Endoscopic resection has become standard therapy for selected patients with early gastric carcinoma (EGC). However, the preoperative diagnostic accuracy for excluding submucosal (SM) invasion is not precise. Moreover, histologic features predicting SM invasion in gastric carcinomas (SMiGC) have not been studied extensively.

Methods

Pre-treatment gastric biopsies from 60 patients with SM invasion who underwent endoscopic resection were reviewed and compared to 58 biopsies of lesions confirmed to be intramucosal carcinomas (IMC). For validation of the results, an independent cohort consisting of 616 gastric biopsies confirmed as EGC were analyzed. For statistical analyses, χ-square test, Fisher’s exact test and multiple logistic progression tests were used.

Results

In the biopsy specimens of patients with SMiGCs, differentiated histology, poorly differentiated component, wisps of muscularis mucosa, tumor cribriforming, papillary architecture, desmoplasia and intraglandular eosinophilic necrotic debris (IEND) were observed in 96.7%, 36.7%, 16.7%, 16.7%, 23.3%, 40%, and 46.7% of cases, respectively, while the same features were observed in 100%, 5.2%, 0%, 1.7%, 5.2%, 19%, and 22.4% of biopsies with IMC. In multivariate analyses, poorly differentiated component [odds ratio (OR), 9.59, p = 0.002], IEND [OR, 6.23, p = 0.012], tumor cribriforming [OR, 4.66, p = 0.03] and papillary architecture [OR, 5.52, p = 0.018] were significantly associated with the detection of SM invasion. In the validation cohort, poorly differentiated component (p = 0.003) and papillary architecture (p = 0.008) remained significant.

Conclusion

Poorly differentiated component and papillary architecture are significant histopathologic predictors of SM invasion in pretreatment gastric biopsies of lesions considered for endoscopic therapy. Additional prospective studies are warranted to confirm our findings.

Virtual slide

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1588557731103084 webcite

【 授权许可】

   
2014 Lee et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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