Gastric superficial neoplasia: high miss rate but slow progression

Abstract

Background and aims Gastric superficial neoplasia (GSN) is often overlooked at endoscopy because of difficulty in identifying it. The miss rate of GSN at endoscopy and the impact on clinical outcome of the missed GSN have not been fully elucidated. In this study, we investigated these issues.

Methods Among 1462 endoscopically and pathologically diagnosed gastric cancers in our hospital from January 2011 to December 2014, previous records of esophagogastroduodenoscopy (EGD) were available for 198 lesions (index lesions) and were reviewed retrospectively. Among those, 157 lesions, which were diagnosed as GSN on the basis of their EGD findings at initial endoscopy, were analyzed. Progression was defined as advanced cancer in the index lesion.

Results Among the 157 GSNs, 118 (75.2 %) had not been recorded in the previous EGD report but were evident upon review of endoscopic photographs for this study. Progression to advanced cancer was observed in only 13 (8.3 %) of the 157 GSNs during a mean interval of 41 months and as long as 96 months, and the rate of progression was similar in missed and not-missed lesions (8.5 % and 7.7 %, respectively). Cumulative incidence rates of progression of missed GSNs to advanced cancer were 0.8 %, 1.7 %, 4.2 %, and 7.6 % at 36, 48, 60, and 72 months after the initial EGD, respectively.

Conclusions Our findings illustrate that GSNs are often missed at endoscopy but progress slowly in most cases. Even though the rate of progression to cancer is relatively low, rigorous attempts should be made to reduce the miss rate of GSNs at EGD.

• References

• 1 Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 2006; 41: 929-942
• 2 Menon S, Trudgill N. How commonly is upper gastrointestinal cancer missed at endoscopy? A meta-analysis . Endosc Int Open 2014; 2: E46-50
• 3 Voutilainen ME, Juhola MT. Evaluation of the diagnostic accuracy of gastroscopy to detect gastric tumors: clinicopathological features and prognosis of patient with gastric cancer missed on endoscopy. Eur J Gastroenterol Hepatol 2005; 17: 1345-1349
• 4 Hosokawa O, Hattori M, Douden K. et al. Difference in accuracy between gastroscopy and colonoscopy for detection of cancer. Hepatogastroenterology 2007; 54: 442-444
• 5 Japanese GastricCancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14: 101-112
• 6 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
• 7 Lauren P. The two histological main types of gastric carcinoma: Diffuse and so-called intestinal-type carcinoma. Acta Pathol Microbiol Scand 1965; 64: 31-49
• 8 Fujita S. Biology of early gastric carcinoma. Pathol Res Pract 1978; 163: 297-309
• 9 Hosokawa O, Kaizaki Y, Nakaya T. et al. Retrospective study of endoscopic findings: 250 cases of gastric cancer. Dig Endosc 2000; 12: 136-140
• 10 Rugge M, Cassaro M, Di Mario F. et al. The long term outcome of gastric non-invasive neoplasia. Gut 2003; 52: 1111-1116
• 11 Park SY, Jeon SW, Jung MK. et al. Long-term follow-up study of gastric intraepithelial neoplasias: progression from low-grade dysplasia to invasive carcinoma. Eur J Gastroenterol Hepatol 2008; 20: 966-970
• 12 Yamada H, Ikegami M, Shimoda T. et al. Long-term follow-up study of gastric adenoma/dysplasia. Endoscopy 2004; 36: 390-396
• 13 Cho SJ, Cho IJ, Kim CG. et al. Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification. Endoscopy 2011; 43: 465-471
• 14 Jung MK, Jeon SW, Park SY. et al. Endoscopic characteristics of gastric adenomas suggesting carcinomatous transformation. Surg Endosc 2008; 22: 2705-2711
• 15 Tsukuma H, Oshima A, Nakahara H. et al. Natural history of early gastric cancer: a non-concurrent, long-term, follow up study. Gut 2000; 47: 618-621
• 16 Uemura N, Okamoto S, Yamamoto S. et al. Helicobacter pylori infection and the development of gastric cancer. NEJM 2001; 345: 784-789
• 17 Fukase K, Kato M, Kikuchi S. et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 2008; 372: 392-397
• 18 Take S, Mizuno M, Ishiki K. et al. The effect of eradicating helicobacter pylori on the development of gastric cancer in patients with peptic ulcer disease. Am J Gastroenterol 2005; 100: 1037-1042
• 19 Ford AC, Forman D, Hunt RH. et al. Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ 2014; 348: g3174
• 20 Ito M, Tanaka S, Takata S. et al. Morphological changes in human gastric tumours after eradication therapy of Helicobacter pylori in a short-term follow-up. Aliment Pharmacol Ther 2005; 21: 559-566