Discrepancies between preand post-endoscopic submucosal dissection clinicopathological findings in early gastric cancer

Abstract

Background: In the treatment of early gastric cancer, patients suitable for endoscopic submucosal dissection (ESD) are selected on the basis of endoscopic findings and biopsy results, while the final diagnosis is confirmed by examination of the resected specimen. Aim: To examine the discrepancies between clinical and pathological findings before and after ESD. Materials and Methods: We retrospectively identified 335 lesions treated by ESD for early gastric cancer at the National Cancer Center between 2020 and 2025, compared the endoscopic, biopsy and pathological findings, and identified the factors associated with discrepancy. Results: At least one of the three pre-treatment parameters was discordant in 175 lesions (52.2%). Of the 249 lesions judged to be ulcer-free on endoscopy, 51 (20.5%) were ulcerated histologically, while 28 lesions were overestimated (P<0.05). Underestimation of ulceration was more likely in lesions located in the upper or middle third of the stomach (OR 2.17, 95% CI 1.22–3.99) and in lesions measuring ≥20 mm (OR 1.68, 95% CI 1.00–2.84). Of the 110 lesions diagnosed as high-grade dysplasia on biopsy, 36 (32.7%) contained adenocarcinoma in the resected specimen, one of which was of undifferentiated type. Of the remaining 18 undifferentiated lesions, 6 (33.3%) had been diagnosed as differentiated type before treatment. Submucosal and lymphovascular invasion were associated with a tumor size of ≥20 mm (OR 3.58 and 3.15) and undifferentiated histology (OR 4.47 and 7.56); all P<0.01. Conclusion: A significant discrepancy was observed between the preand post-ESD clinicopathological findings.