Risk Factors Associated With Histopathological Upgrade Of The Gastric Intraepithelial Neoplasia

BackgroundGastric intraepithelial neoplasia（IN）is the precancerous lesion of gastric cancer（GC）,and without intervention,it can gradually progress to advanced gastric cancer with the ability of invasion and metastasis.At present,endoscopic forceps biopsy is regarded as the reference standard for the diagnosis of IN.However,in clinical practice,the histopathological discrepancy between endoscopic forceps biopsy and resection are not uncommon.In recent years,several studies have shown that the histopathological upgrade of IN initially diagnosed by endoscopic forceps biopsy is not uncommon,and this will have a great impact on the choice of treatment strategies.The occurrence of gastric precancerous lesions and gastric cancer usually present with the changes of microsurface pattern and microvascular pattern,which are crucial for the diagnosis of neoplasia.Magnifying endoscopy combined with narrow band imaging（ME-NBI）can clearly observe the changes of the microsurface pattern and microvascular pattern of the gastric mucosa,thus identify lesions that are difficult to distinguish under white light endoscopy.With the application of ME-NBI,endoscopists can identify high risk IN lesions and make proper choices for patients with IN.AimsOur study aimed to analyze the risk factors associated with histopathological upgrade of the IN initially diagnosed by endoscopic forceps biopsy,and provide certain reference for the treatment of patients with IN,especially patients with low-grade intraepithelial neoplasia（LGIN）.Materials and methodsMedical data of patients who were diagnosed as IN by the endoscopic forceps biopsy and underwent ME-NBI examination before resection at Nanfang Hospital from January 2010 to December 2019 were retrospectively analyzed,and risk factors associated with histopathological upgrade of the IN by endoscopic forceps biopsy were evaluated.ResultsA total of 268 lesions were included in this study.Among them,the number of lesions diagnosed as LGIN and high-grade intraepithelial neoplasia（HGIN）under endoscopic forceps biopsy was 158 and 110,respectively.Among the 158 LGIN lesions,the number of lesions confirmed to be LGIN,HGIN,and GC were 84（53.2%）,68（43.0%）,4（2.5%）,respectively.Among the 110 HGIN lesions,16（14.6%）,74（67.3%）,and 20（18.2%）lesions were confirmed to be LGIN,HGIN,and GC,respectively.With postoperative histopathological results as the reference standard,lesions were divided into IN group and GC group.Logistic regression analysis showed that lesions located on the upper 1/3 of the stomach（OR value=6.764,95%CI:1.85424.677）,surface ulcer（OR value=3.139,95%CI:1.124-8.768）,surface unevenness（OR value=3.011,95%CI:1.706-8.422）,lesions with demarcation line combined with irregular microsurface pattern（DL+ IMSP）（OR value=11.934,95%CI:2.661-53.511）were risk factors for IN upgraded to GC after resection.We further analyzed lesions initially diagnosed as LGIN by endoscopic forceps biopsy.According to the postoperative histopathological results,lesions were divided into consistent group and upgraded group.Logistic regression analysis showed that lesions with demarcation line combined with irregular microvascular pattern（DL+IMVP）（OR value=3.198,95%CI:1.456-7.024）and microvascular dilation（OR value=2.824,95%CI:1.336-5.973）were predictive factors for LGIN upgraded to HGIN or GC after resection.ConclusionsOur study suggests that IN lesions that are located in the upper third of the stomach（fundus or cardia）,surface ulcers,surface unevenness or a demarcation line with irregular microsurface pattern,it is recommended to fully evaluate the depth of invasion,lymph node metastasis and vascular invasion before endoscopic or surgical resection.For LGIN lesions with a demarcation line and irregular microvascular pattern or microvascular dilation under ME-NBI,endoscopic resection is highly recommended to obtain accurate histopathological results,while regular endoscopic follow-up is recommended if there is no evidence of risk factors.