| Diagnostic Value of Endoscopic Mucosal Resection in Low Grade Dysplasia of
Gastric Mucosa |
| 저도 이형성을 보인 위 점막병변에서 내시경 점막절제술의 진단적 의의 |
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이주엽; 장병국; 조광범; 이경인; 서혜진; 김현아; 정우진; 박경식; 황재석; 안성훈; 강유나 |
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| Abstract |
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Gastric adenoma with high grade dysplasia has been regarded as a premalignant
lesion. Surgical or endoscopic mucosal resection (EMR) was recommended to treat high grade
dysplasia. On the other hand; low grade dysplasia have been regarded as relatively low risk of
malignant transformation. However; variable histological grades might be presented at single
dysplastic lesion and so endoscopic forceps biopsy (EFB) might not represent whole pathologic
lesion. Thus we evaluated the histologic discrepancy between EFB and EHR in patients with low
grade dysplasia. We reviewed retrospectively 142 patients (M:F=84:58) undergone EMR who had
been diagnosed as low grade dysplasia by EFB from 1998 to 2005. Mean age of the patients was
62.6 years old (28~77 years). Of 142 patients; the pathologic examination through the EMR
showed 7 cases (4.9%) of adenocarcinoma; 15 cases (10.6%) of high grade dysplasia; 102 cases
(71.8%) of low grade dysplasia; 4 cases (2.8%) of hyperplastic polyp; 14 case (9.9%) of chronic
gastritis. Twenty two cases (15.5%) among 142 cases were upgraded in the histologic staging to
carcinoma or high grade dysplasia. We found in reddish surface color endoscopic features; having
statistically significant relationships with adenocarcinoma at the final pathological diagnosis. In
conclusion; although low grade dysplasia was diagnoses initially by EFB; endoscopic mucosal
resection might be need to confirm an accurate diagnosis and treatment; especilly; when the lesion
was reddish surface color. The reason is due to that focal adenocarcinoma can be exit around low
grade dysplasia lesion. |
| Key Words:
Endoscopic forceps biopsy, Endoscopic mucosal resection, Low grade dysplasia |
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