TY - JOUR
T1 - Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia
T2 - An analysis using the Vienna classification
AU - Cho, S. J.
AU - Choi, I. J.
AU - Kim, C. G.
AU - Lee, J. Y.
AU - Kook, M. C.
AU - Park, S.
AU - Ryu, K. W.
AU - Lee, J. H.
AU - Kim, Y. W.
PY - 2011
Y1 - 2011
N2 - Background and aims: Therapeutic guidelines have not yet been established for low-grade gastric adenomas/dysplasias (LGD), which have a low risk of progression to high-grade adenomas/ dysplasias (HGD) or to invasive carcinomas. This study aimed to evaluate risk factors for HGD/carcinoma that indicate a need for resection in biopsy- proven LGD lesions. Patients and methods: In total, 236 LGD lesions from 208 consecutive patients treated with endoscopic resection (ER) were retrospectively studied between 2004 and 2008. The Vienna classification was used for histological diagnosis. A generalized estimating equation (GEE) logistic regression model was used for multivariate analysis. Results: Among the 236 LGD lesions, the final pathology diagnosed 9 (3.8 %) as invasive carcinoma (category 5), 71 (30.1 %) as HGD (category 4), 148 (62.7 %) as LGD (category 3), and 8 (3.4 %) as negative/indefinite for dysplasia (category 1/2). Lesions ≥ 1 cm were classified as HGD/carcinoma in 39.4% of patients (65/165). Multivariate analysis indicated that size of ≥ 1 cm (OR 1.93 [95% CI, 1.06-3.52]), depressed morphology (OR 3.81 [95% CI, 1.22-11.9]), and erythema (OR 2.49 [95% CI, 1.31-4.72]) were significantly associated with HGD/carcinoma. The OR increased to 47.6 (95% CI, 4.27-530.65) when the risk factors were all positive. The sensitivity and negative predictive value for ≥ 1 risk factors were 93.8% and 90.9 %, respectively. As the number of risk factors of a lesion increased, the specificity and positive predictive value also increased. Conclusions: Endoscopic resection can be recommended if a low-grade dysplastic lesion has at least one of the following risk factors: depressed morphology, surface erythema, or a size of 1 cm or greater. For lesions that have none of the three risk factors, follow-up endoscopy is recommended.
AB - Background and aims: Therapeutic guidelines have not yet been established for low-grade gastric adenomas/dysplasias (LGD), which have a low risk of progression to high-grade adenomas/ dysplasias (HGD) or to invasive carcinomas. This study aimed to evaluate risk factors for HGD/carcinoma that indicate a need for resection in biopsy- proven LGD lesions. Patients and methods: In total, 236 LGD lesions from 208 consecutive patients treated with endoscopic resection (ER) were retrospectively studied between 2004 and 2008. The Vienna classification was used for histological diagnosis. A generalized estimating equation (GEE) logistic regression model was used for multivariate analysis. Results: Among the 236 LGD lesions, the final pathology diagnosed 9 (3.8 %) as invasive carcinoma (category 5), 71 (30.1 %) as HGD (category 4), 148 (62.7 %) as LGD (category 3), and 8 (3.4 %) as negative/indefinite for dysplasia (category 1/2). Lesions ≥ 1 cm were classified as HGD/carcinoma in 39.4% of patients (65/165). Multivariate analysis indicated that size of ≥ 1 cm (OR 1.93 [95% CI, 1.06-3.52]), depressed morphology (OR 3.81 [95% CI, 1.22-11.9]), and erythema (OR 2.49 [95% CI, 1.31-4.72]) were significantly associated with HGD/carcinoma. The OR increased to 47.6 (95% CI, 4.27-530.65) when the risk factors were all positive. The sensitivity and negative predictive value for ≥ 1 risk factors were 93.8% and 90.9 %, respectively. As the number of risk factors of a lesion increased, the specificity and positive predictive value also increased. Conclusions: Endoscopic resection can be recommended if a low-grade dysplastic lesion has at least one of the following risk factors: depressed morphology, surface erythema, or a size of 1 cm or greater. For lesions that have none of the three risk factors, follow-up endoscopy is recommended.
UR - http://www.scopus.com/inward/record.url?scp=80555144525&partnerID=8YFLogxK
U2 - 10.1055/s-0030-1256236
DO - 10.1055/s-0030-1256236
M3 - Article
C2 - 21425043
AN - SCOPUS:80555144525
VL - 43
SP - 465
EP - 471
JO - Endoscopy
JF - Endoscopy
SN - 0013-726X
IS - 6
ER -