Spectrum of final pathological diagnosis of gastric adenoma after endoscopic resection

Table 1 The baseline characteristics and endoscopic features of referred adenomas n (%)

No. of cases	554
No. of patients	534
Age (yr), mean ± SD	62.1 ± 9.6
Male:female	372:182 (2.04:1)
Histologic grade
Adenoma (no grading)	92 (16.6)
Low grade	382 (69.0)
High grade	80 (14.4)
No. of referring hospitals	116
No. of Bx, mean ± SD	2.24 ± 1.75
Mean duration between biopsy and procedure	40.7 d
Information of endoscopic photo	449 (81.0)
Size (cm), mean ± SD	1.2 ± 0.8
Morphologic type
Elevated	275 (49.6)
Flat	206 (37.2)
Depressed	67 (12.1)
Y-IV	6 (1.1)
Color
Whitish	332 (59.9)
Reddish	94 (17.0)
Mixed or undetermined	128 (23.1)
Longitudinal location
Antrum	298 (53.8)
Angle	57 (10.3)
Body	191 (34.4)
High	12 (2.2)
Middle	55 (9.9)
Lower	124 (22.4)
Cardia or fundus	8 (1.5)
Circular location
Anterior	123 (22.2)
Posterior	119 (21.5)
Lesser curvature	193 (34.8)
Greater curvature	113 (20.4)

Bx: Biopsy; Y-IV: Yamada type IV.

Table 2 Treatment results of referred adenomas n (%)

Repeat endoscopy	142 (25.6)
Repeat biopsy	108 (19.5)
No. of biopsy, mean ± SD	2.4 ± 1.0
Histologic results of repeat biopsy
Low grade adenoma	73 (67.6)
High grade adenoma	9 (8.3)
Adenocarcinoma	18 (16.7)
Gastritis	7 (6.5)
Others	1 (0.9) (MALToma)
Endoscopist
1	462 (83.4)
2	64 (11.6)
3	28 (5.1)
Pathologist
1	340 (61.4)
2	124 (22.4)
3	83 (15.0)
Others	8 (1.1)
Histologic type; tubulovillous adenoma	10 (1.8)
Type of procedure
EMR	387 (69.9)
ESD	167 (30.1)
Histologic results of post-procedure
Low grade adenoma	356 (64.3)
High grade adenoma	68 (12.3)
EGC	72 (13.0)
No adenomatous lesion	56 (10.1)
Others	2 (0.4) (MALToma: 1, transfer by Cx: 1)
Complication
Bleeding	14 (2.5)
Perforation	2 (0.4)
Stricture	2 (0.4)
Cases with multiple adenoma
2 adenoma in a patient	12 patients/534 (2.2)
3 adenoma in a patient	4 patients/534 (0.7)

MALToma: Mucosa associated lymphoid tissue lymphoma; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; EGC: Early gastric cancer; Cx: Complication.

Table 3 Comparisons of histologic diagnoses n (%)

	LG	HG	EGC	NAL	Others	Total	Agreement	Discrepancy
Between local clinic biopsy and repeat biopsy
Adenoma	11 (68.8)	3 (18.8)	0 (0)	1 (6.3)	1 (6.3)	16 (100)
LG	51 (83.6)	4 (6.6)	2 (3.3)	4 (6.6)	0 (0)	61 (100)	51 (83.6)	10 (16.4)
HG	11 (35.5)	2 (6.5)	16 (51.6)	2 (6.5)	0 (0)	31 (100)	2 (6.5)	29 (93.5)
Total	73 (67.6)	9 (8.3)	18 (16.7)	7 (6.5)	1 (0.9)	108 (100)	53 (57.6)	39 (42.4)
Between local clinic and post procedure
Adenoma	60 (65.2)	14 (15.2)	6 (6.5)	11 (12.0)	1 (1.1)	92 (100)
LG	274 (71.7)	42 (11.0)	22 (5.8)	43 (11.3)	1 (0.3)	382 (100)	274 (71.7)	108 (28.3)
HG	22 (27.5)	12 (15.0)	44 (55.0)	2 (2.5)	0 (0)	80 (100)	12 (15.0)	68 (85.0)
Total	356 (64.3)	68 (12.3)	72 (13.0)	56 (10.1)	2 (0.4)	554 (100)	286 (61.9)	176 (38.1)
Between repeat forcep biopsy and post procedure
LG	52 (71.2)	1 (15.1)	6 (8.2)	3 (4.1)	1 (1.4)	73 (100)	52 (71.2)	21 (28.8)
HG	3 (33.3)	4 (44.4)	2 (22.2)	0 (0)	0 (0)	9 (100)	4 (44.4)	5 (45.6)
Adenocarcinoma	0 (0)	0 (0)	17 (94.4)	1 (5.6)	0 (0)	18 (100)	17 (94.4)	1 (5.6)
Benign lesion	3 (42.9)	0 (0)	2 (28.6)	2 (28.6)	0 (0)	7 (100)	2 (28.6)	5 (71.4)
Others	0 (0)	0 (0)	0 (0)	0 (0)	1 (100)	1 (100)	1 (100)	0 (0)
Total	58 (53.7)	15 (13.9)	27 (25.0)	6 (5.6)	2 (1.9)	108 (100)	76 (70.4)	32 (29.6)

LG: Low grade; HG: High grade; NAL: No adenomatous lesion; EGC: Early gastric cancer.

Table 4 Results of re-endoscopic forceps biopsy according to endoscopists and pathologists n (%)

	LG	HG	Ade	NAL	Others	Total
Endoscopist
1	34 (54.0)	6 (9.5)	18 (28.6)	4 (6.3)	1 (1.6)	63
2	36 (92.3)	3 (7.7)	0	0	0	39
3	3 (50.0)	0	0	3 (50.0)	0	6
Pathologist
1	40 (64.5)	4 (6.5)	15 (24.2)	2 (3.2)	1 (1.6)	62
2	20 (66.7)	4 (13.3)	2 (6.7)	4 (13.3)	0	30
3	8 (80.0)	1 (10.0)	1 (10.0)	0	0	10
Others	5 (83.3)	0	0	1 (16.7)	0	6
Deletion of minority
	Adenocarcinoma		Non-adenocarcinoma			P value
Endoscopist
1	18 (28.6)		45 (71.4)			< 0.001
2	0 (0)		39 (100)
Pathologist
1	15 (24.2)		47 (77.8)			0.048
2	2 (6.7)		15 (93.3)

Ade: Adenocarcinoma; LG: Low grade; HG: High grade; NAL: No adenomatous lesion.

Table 5 Comparison of the non-malignancy group and the malignancy group n (%)

	Non-malignancy group	Malignancy group	P value
No. of cases	482 (87.0)	72 (13.0)
No. of patients	462 (86.5)	72 (13.5)
Age (yr), mean ± SD	61.8 ± 9.8	63.7 ± 9.0	0.132
Sex
Male	320 (86.0)	52 (14.0)	0.350
Female	162 (89.0)	20 (11.0)
Histologic grade
Adenoma	86 (93.5)	6 (6.5)	< 0.001
Low grade	360 (94.2)	22 (5.8)
High grade	36 (45.0)	44 (55.0)
Histologic type
Tubulovillous	7 (70)	3 (30)	0.129
Tubular	475 (83.3)	69 (12.7)
No. of Bx, mean ± SD	2.1 ± 1.6	2.9 ± 2.2	< 0.001
No. of biopsy
Undetermined	111 (86.0)	18 (14.0)
1	47 (92.2)	4 (7.8)
2	117 (94.4)	7 (5.6)
3	105 (92.1)	9 (7.9)
4	47 (72.3)	18 (27.7)
5	25 (80.6)	6 (19.4)
6	12 (70.6)	5 (29.4)
7	1 (33.3)	2 (66.7)
8	1 (33.3)	2 (66.7)
3	269 (93.1)	20 (6.9	< 0.001
4	86 (72.3)	33 (27.7)
Mean duration between Bx and procedure (d)	40.9	39.3	0.869
Duration between biopsy and procedure
14 d	24 (92.3)	2 (7.7)	0.658
90 d	29 (87.9)	4 (12.1)
Size (cm), mean ± SD	1.2 ± 0.8	1.5 ± 1.1	0.003
< 1.0	201 (89.7)	23 (10.3)	0.010
> 1.0, < 2.0	218 (87.9)	30 (12.1)
> 2.0	63 (76.8)	19 (23.2)
Morphologic type
Elevated	252 (91.6)	23 (8.4)	< 0.001
Flat	187 (90.8)	19 (9.2)
Depressed	43 (64.2)	24 (35.8)
Y-IV	0 (0)	6 (100)
Color
Whitish	321 (96.7)	11 (3.3)	< 0.001
Reddish	65 (69.1)	29 (30.9)
Mixed or undetermined	96 (75.0)	32 (25.0)
Longitudinal location
Antrum	255 (85.6)	43 (14.4)	0.291
Angle	47 (82.5)	10 (17.5)
Body	173 (90.6)	18 (9.4)
Cardia or fundus	7 (87.5)	1 (12.5)
Circular location
Anterior	104 (84.6)	19 (15.4)	0.573
Posterior	107 (89.9)	12 (10.1)
Lesser curvature	171 (88.6)	22 (11.4)
Greater curvature	95 (84.1)	18 (15.9)
Type of procedure
EMR	371 (95.9)	16 (4.1)	< 0.001
ESD	111 (66.5)	56 (33.5)
Repeat endoscopy
Yes	110 (77.5)	32 (22.5)	< 0.001
No	372 (90.3)	40 (9.7)
Endoscopist
1	397 (85.6)	65 (14.1)	0.204
2	60 (93.8)	4 (6.3)
3	25 (89.3)	3 (10.7)
Pathologist
1	284 (83.5)	56 (16.5)	0.027
2	117 (94.4)	7 (5.6)
3	74 (89.2)	9 (10.8)
Others	6 (100)	0 (0)
Local clinics (> 30 cases)
1	39 (95.1)	2 (4.9)	0.224
2	37 (90.2)	4 (9.8)
3	35 (97.2)	1 (2.8)
4	28 (84.8)	5 (15.2)
Complication
Bleeding	9 (64.3)	5 (35.7)
Perforation	1 (50)	1 (50)
Stricture	1 (50)	1 (50)
Total complications	11 (61.1)	7 (38.9)	0.005
No complications	471 (87.9)	65 (12.1)
Multiplicity
Patient of single case	449 (86.7)	69 (13.3)	0.464
Patient of multiple cases	13 (81.3)	3 (18.8)

Bx: Biopsy; Y: Yamada type; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.

Table 6 Odds ratio of risk factors for malignancy as a final diagnosis

	Odds ratio
High grade dysplasia	19.5
Biopsy number ≥ 4	5.1
Size ≥ 2.0 cm	2.4
Depressed or Y-III, Y-IV	7.3
Reddish or undetermined	11.1
ESD	11.7
Repeat endoscopy	2.7
Pathologist 1	2.4
Complications	4.6

ESD: Endoscopic submucosal dissection; Y: Yamada type.