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Low Discrepancy Between Tissue Biopsy Plus Magnifying Endoscopy With Narrow-Band Imaging and Endoscopic Resection in the Diagnosis of Gastric Epithelial Neoplasia (STROBE).

Zhang Q, Lian ZY, Chen ZY, Wang Z, di Chen C, An SL, Gong W, Zhi FC, de Liu S - Medicine (Baltimore) (2015)

Bottom Line: Tissue biopsy is often not very accurate for the diagnosis of gastric epithelial neoplasia (GEN), and the results differ notably from endoscopic resection (ER) in terms of the pathological diagnosis.Factors that contributed to such discrepancies were analyzed.The sensitivity and specificity for HGN were 45.8% (33.7%-58.3%) and 100% (87.5%-100%) for biopsy, and 88.1% (77.5%-94.1%) and 92.9% (81.0%-97.5%) for ME-NBI, respectively.In conclusion, biopsy-based diagnoses for GEN should be interpreted with caution.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Gastroenterology (QZ, ZYC, ZW, CDC, WG, FCZ, SDL), Nanfang Hospital, Southern Medical University; Department of Radiology (ZYL), Guangdong General Hospital, Guangdong Academy of Medical Sciences; and Department of Bio-Statistics (SLA), School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China.

ABSTRACT
Tissue biopsy is often not very accurate for the diagnosis of gastric epithelial neoplasia (GEN), and the results differ notably from endoscopic resection (ER) in terms of the pathological diagnosis. The aims of this study were to evaluate the diagnostic performances of biopsy, magnifying endoscopy with narrow-band imaging (ME-NBI), and biopsy plus ME-NBI for GEN.This study retrospectively analyzed 101 cases diagnosed as GEN using ER samples. The discrepancies between biopsy and ER, as well as between biopsy plus ME-NBI and ER in the diagnosis of GEN were evaluated. Factors that contributed to such discrepancies were analyzed. The sensitivity and specificity of biopsy and ME-NBI for the diagnosis of high-grade neoplasia (HGN) were determined.The discrepancy in the pathological diagnosis between biopsy and ER was 39.6% for GEN and 54.2% for HGN. The discrepancy between biopsy combined with ME-NBI and ER was 15.9% for GEN and 10.2% for HGN. Factors that undermined the diagnostic accuracy of biopsy included the lesion size (≤10 mm, odds ratio [OR] 1; 10-20 mm, OR 0.2, 95% confidence interval [CI] 0.1-0.7; >20 mm, OR 0.5, 95% CI 0.1-2.1, P = 0.03) and the number of biopsy fragments (OR 0.6, 95% CI 0.5-0.8, P = 0.001). The sensitivity and specificity for HGN were 45.8% (33.7%-58.3%) and 100% (87.5%-100%) for biopsy, and 88.1% (77.5%-94.1%) and 92.9% (81.0%-97.5%) for ME-NBI, respectively.In conclusion, biopsy-based diagnoses for GEN should be interpreted with caution. Biopsy combined with ME-NBI can contribute to the diagnosis of GEN, which improves diagnostic consistency with pathological result of ER specimens.

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Related in: MedlinePlus

A recommended diagnosis and treatment process for suspected gastric lesions. No matter what the results of tissue biopsy (Biopsy [−]/[+]) is, while the lesion under ME-NBI shows typical features of gastric cancer, ER should still be considered to establish a definite diagnosis and determine proper treatment options. In this study, 55 cases had typical characteristics of gastric cancer on ME-NBI, of which 52 cases were confirmed as HGN by pathological analysis after ER. If the ME-NBI results are negative, treatment options may be determined based on the biopsy results by following the Vienna classification of gastrointestinal epithelial neoplasia. ER = endoscopic resection, HGN = high-grade neoplasia, ME-NBI = magnifying endoscopy with narrow-band imaging.
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Figure 2: A recommended diagnosis and treatment process for suspected gastric lesions. No matter what the results of tissue biopsy (Biopsy [−]/[+]) is, while the lesion under ME-NBI shows typical features of gastric cancer, ER should still be considered to establish a definite diagnosis and determine proper treatment options. In this study, 55 cases had typical characteristics of gastric cancer on ME-NBI, of which 52 cases were confirmed as HGN by pathological analysis after ER. If the ME-NBI results are negative, treatment options may be determined based on the biopsy results by following the Vienna classification of gastrointestinal epithelial neoplasia. ER = endoscopic resection, HGN = high-grade neoplasia, ME-NBI = magnifying endoscopy with narrow-band imaging.

Mentions: This study compared the sensitivity and specificity of ME-NBI and biopsy for the diagnosis of high-grade gastric neoplasia. ME-NBI yielded a high sensitivity and a relatively low specificity, whereas biopsy had a low sensitivity and a high specificity. There was a large discrepancy in the pathological diagnosis between biopsy and ER. With this in mind, we recommend that the combination of biopsy and ME-NBI is considered for the diagnosis of suspected lesions in order to reduce missed diagnoses and misdiagnoses of HGN. If biopsy does not suggest HGN whereas ME-NBI shows typical features of gastric cancer, ER should still be considered to establish a definite diagnosis and determine proper treatment options. In this study, 55 cases had the typical characteristics of gastric cancer on ME-NBI, of which 52 cases were confirmed as HGN by pathological analysis after ER. If the ME-NBI results are negative, treatment options may be determined based on the biopsy results by following the Vienna classification of gastrointestinal epithelial neoplasia. However, it should be noted that a certain percentage of biopsy-proven LGN may be identified as HGN after ER. In this study, 38 cases did not show the typical characteristics of gastric cancer on ME-NBI and were diagnosed as LGN by biopsy; however, pathological analysis after ER suggested that there were 6 cases of HGN. Therefore, particular attention is needed for biopsy-proven LGN, and ER or close follow-up should be performed. Figure 2 shows the recommended diagnosis and treatment process as well as the number of cases included in this study.


Low Discrepancy Between Tissue Biopsy Plus Magnifying Endoscopy With Narrow-Band Imaging and Endoscopic Resection in the Diagnosis of Gastric Epithelial Neoplasia (STROBE).

Zhang Q, Lian ZY, Chen ZY, Wang Z, di Chen C, An SL, Gong W, Zhi FC, de Liu S - Medicine (Baltimore) (2015)

A recommended diagnosis and treatment process for suspected gastric lesions. No matter what the results of tissue biopsy (Biopsy [−]/[+]) is, while the lesion under ME-NBI shows typical features of gastric cancer, ER should still be considered to establish a definite diagnosis and determine proper treatment options. In this study, 55 cases had typical characteristics of gastric cancer on ME-NBI, of which 52 cases were confirmed as HGN by pathological analysis after ER. If the ME-NBI results are negative, treatment options may be determined based on the biopsy results by following the Vienna classification of gastrointestinal epithelial neoplasia. ER = endoscopic resection, HGN = high-grade neoplasia, ME-NBI = magnifying endoscopy with narrow-band imaging.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4504654&req=5

Figure 2: A recommended diagnosis and treatment process for suspected gastric lesions. No matter what the results of tissue biopsy (Biopsy [−]/[+]) is, while the lesion under ME-NBI shows typical features of gastric cancer, ER should still be considered to establish a definite diagnosis and determine proper treatment options. In this study, 55 cases had typical characteristics of gastric cancer on ME-NBI, of which 52 cases were confirmed as HGN by pathological analysis after ER. If the ME-NBI results are negative, treatment options may be determined based on the biopsy results by following the Vienna classification of gastrointestinal epithelial neoplasia. ER = endoscopic resection, HGN = high-grade neoplasia, ME-NBI = magnifying endoscopy with narrow-band imaging.
Mentions: This study compared the sensitivity and specificity of ME-NBI and biopsy for the diagnosis of high-grade gastric neoplasia. ME-NBI yielded a high sensitivity and a relatively low specificity, whereas biopsy had a low sensitivity and a high specificity. There was a large discrepancy in the pathological diagnosis between biopsy and ER. With this in mind, we recommend that the combination of biopsy and ME-NBI is considered for the diagnosis of suspected lesions in order to reduce missed diagnoses and misdiagnoses of HGN. If biopsy does not suggest HGN whereas ME-NBI shows typical features of gastric cancer, ER should still be considered to establish a definite diagnosis and determine proper treatment options. In this study, 55 cases had the typical characteristics of gastric cancer on ME-NBI, of which 52 cases were confirmed as HGN by pathological analysis after ER. If the ME-NBI results are negative, treatment options may be determined based on the biopsy results by following the Vienna classification of gastrointestinal epithelial neoplasia. However, it should be noted that a certain percentage of biopsy-proven LGN may be identified as HGN after ER. In this study, 38 cases did not show the typical characteristics of gastric cancer on ME-NBI and were diagnosed as LGN by biopsy; however, pathological analysis after ER suggested that there were 6 cases of HGN. Therefore, particular attention is needed for biopsy-proven LGN, and ER or close follow-up should be performed. Figure 2 shows the recommended diagnosis and treatment process as well as the number of cases included in this study.

Bottom Line: Tissue biopsy is often not very accurate for the diagnosis of gastric epithelial neoplasia (GEN), and the results differ notably from endoscopic resection (ER) in terms of the pathological diagnosis.Factors that contributed to such discrepancies were analyzed.The sensitivity and specificity for HGN were 45.8% (33.7%-58.3%) and 100% (87.5%-100%) for biopsy, and 88.1% (77.5%-94.1%) and 92.9% (81.0%-97.5%) for ME-NBI, respectively.In conclusion, biopsy-based diagnoses for GEN should be interpreted with caution.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Gastroenterology (QZ, ZYC, ZW, CDC, WG, FCZ, SDL), Nanfang Hospital, Southern Medical University; Department of Radiology (ZYL), Guangdong General Hospital, Guangdong Academy of Medical Sciences; and Department of Bio-Statistics (SLA), School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China.

ABSTRACT
Tissue biopsy is often not very accurate for the diagnosis of gastric epithelial neoplasia (GEN), and the results differ notably from endoscopic resection (ER) in terms of the pathological diagnosis. The aims of this study were to evaluate the diagnostic performances of biopsy, magnifying endoscopy with narrow-band imaging (ME-NBI), and biopsy plus ME-NBI for GEN.This study retrospectively analyzed 101 cases diagnosed as GEN using ER samples. The discrepancies between biopsy and ER, as well as between biopsy plus ME-NBI and ER in the diagnosis of GEN were evaluated. Factors that contributed to such discrepancies were analyzed. The sensitivity and specificity of biopsy and ME-NBI for the diagnosis of high-grade neoplasia (HGN) were determined.The discrepancy in the pathological diagnosis between biopsy and ER was 39.6% for GEN and 54.2% for HGN. The discrepancy between biopsy combined with ME-NBI and ER was 15.9% for GEN and 10.2% for HGN. Factors that undermined the diagnostic accuracy of biopsy included the lesion size (≤10 mm, odds ratio [OR] 1; 10-20 mm, OR 0.2, 95% confidence interval [CI] 0.1-0.7; >20 mm, OR 0.5, 95% CI 0.1-2.1, P = 0.03) and the number of biopsy fragments (OR 0.6, 95% CI 0.5-0.8, P = 0.001). The sensitivity and specificity for HGN were 45.8% (33.7%-58.3%) and 100% (87.5%-100%) for biopsy, and 88.1% (77.5%-94.1%) and 92.9% (81.0%-97.5%) for ME-NBI, respectively.In conclusion, biopsy-based diagnoses for GEN should be interpreted with caution. Biopsy combined with ME-NBI can contribute to the diagnosis of GEN, which improves diagnostic consistency with pathological result of ER specimens.

Show MeSH
Related in: MedlinePlus