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. 2017 Sep;96(36):e8044.
doi: 10.1097/MD.0000000000008044.

Predictive factors to diagnosis undifferentiated early gastric cancer after endoscopic submucosal dissection

Dae G Ryu  1 , Cheol W Choi, Dae H Kang, Hyung W Kim, Su B Park, Su J Kim, Hyeong S Nam
Affiliations

Predictive factors to diagnosis undifferentiated early gastric cancer after endoscopic submucosal dissection

Dae G Ryu et al. Medicine (Baltimore). 2017 Sep.

Abstract

It is difficult to predict precisely whether the lesion corresponds to endoscopic resection indication. Furthermore, discrepancy may occur between endoscopic forceps biopsy (EFB) and finally resected specimen, which may be diagnosed as undifferentiated cancer and additional surgery may be required. Our study aimed to evaluate predictive factors to diagnose undifferentiated cancer after endoscopic submucosal dissection (ESD).Among the 532 patients diagnosed by ESD between January 2009 and December 2015, 557 early gastric cancer (EGC) cases were studied. Factors predicting diagnosis of undifferentiated cancer and clinical outcomes of the lesions were retrospectively analyzed.Among the 557 cases with EGC, 535 (96.1%) were diagnosed as differentiated cancer and 22 (3.9%) as the undifferentiated type with ESD. Tumor size was larger (mean size 20.67 vs 13.59 mm, P < .001) and age was lower (60.24 vs 64.50 years, P < .001) in the group with undifferentiated cancer. En bloc resection rate was similar (95.5% vs 95.9%, P = .886), but the complete resection rate was lower (72.7% vs 92.4%, P < .001) in the group with undifferentiated cancer. On multivariate analysis, tumor size ≥10 mm (OR = 11.340, P = .032), age <55 years (OR = 5.972, P = .004), surface redness (OR = 11.562, P = .024), and whitish discoloration (OR = 35.368, P < .001) were predominantly associated with undifferentiated cancer.Young age (<55 years), large tumor size (≥10 mm), surface redness, and whitish discoloration are predictors of undifferentiated cancer, and lesions with these features detected need to be treated cautiously.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart showing lesions in patients enrolled in the study. EGC = early gastric cancer, ESD = endoscopic submucosal dissection.
Figure 2
Figure 2
A case of poorly differentiated adenocarcinoma in a 44-year-old woman. A, Conventional endoscopic image: the lesion located in the anterior antral wall with surface redness and whitish discoloration. B,C, Endoscopic findings during ESD. D, En bloc resected ESD specimen (long diameter 3.1 cm). E, Pathologically diagnosed adenocarcinoma confined to mucosa. F, H&E stain, 400 × magnification, moderately to poorly differentiated adenocarcinoma. ESD = endoscopic submucosal dissection.
Figure 3
Figure 3
Undifferentiated cancers with surface redness (A) and whitish discoloration (B). A, The lesion located at lower body lesser curvature in lower body with surface redness. B, The lesion located at anterior wall in antrum with whitish discoloration.
Figure 4
Figure 4
Flow diagram showing the undifferentiated cancer group.
See this image and copyright information in PMC

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