Pathologic Upgraded after Endoscopic Submucosal Dissection of Gastric Low-grade Intraepithelial Neoplasia
Objective To explore the risk factors for postoperative pathologic upgrading after endoscopic submucosal dissection(ESD)in patients with endoscopic biopsy diagnosis of gastric low-grade intraepithelial neoplasia(LGIN).Methods The clinicopatho-logical data of patients who underwent ESD at the Second Hospital of Lanzhou University between January 2013 and July 2023 and were di-agnosed with LGIN by preoperative endoscopic biopsy pathology were retrospectively analyzed.The patients were divided into the upgraded group(83 cases)and the un-upgraded group(61 cases)according to the pathological findings after ESD,and the risk factors for patho-logical upgrading of LGIN were explored using univariate and multivariate Logistic regression analyses.Results A total of 144 patients were included;61 lesions remained LGIN after ESD,37 were upgraded to high-grade intraepithelial neoplasia(HGIN),and 46 were upgraded to early gastric cancer(EGC).The pathologic upgrade rate of endoscopic biopsy of LGIN was 57.6％.Comparison of lesion size,spontaneous bleeding,and irregular microvascular pattern(IMVP)between the two groups showed statistically significant differences(P＜0.05);however,no statistically significant difference between the two groups was observed for gender,age,surface redness,sur-face nodules,surface ulcers,site,and morphology(P＞0.05).The results of multivariate Logistic regression analysis showed that lesion size ≥2cm(P=0.006)and IMVP(+)(P=0.027)were independent risk factors for pathologic upgrade after ESD in LGIN patients.Conclusion The consistency between endoscopic biopsy diagnosis of LGIN and postoperative pathologic diagnosis of ESD was poor,and biopsy could not be used as its final diagnosis;patients with LGIN whose lesion size was ≥2cm and IM VP(+)should be alerted to the possibility of pathological upgraded,and it was recommended that ESD be performed to remove the lesion.
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