The Clinical Features And Risk Factors For Misdiagnosis Of Gastric Intraepithelial Neoplasia Diagnosed By Endoscopic Forceps Biopsy

Objective Explore the analysis of clinical features and risk factors for misdiagnosis of gastric intraepithelial neoplasia(GIN)diagnosed by endoscopic forceps biopsy,to improve the diagnosis accuracy of gastric intraepithelial neoplasia.Methods A total of 203 patients with GIN diagnosed by endoscopic forceps biopsy were collected from December 2010 to December 2016 retrospectively.we described the information of all cases,including gender,age,clinical symptoms,the location,size,endoscopic morphology,histological type of the lesion,treatment methods.Results GIN was mostly frequently detected in male patients(ratio was 2.63:1)and over the age of 60 years(66.5%).GIN was mostly located in gastric antrum and gastric angle,the rate altogether was 70.9%;lesion size larger than 1.0 cm accounted for 78.3%;Endoscopic morphology was divided into three categories:protruding(21.2%),flat(58.6%),and excavated(20.2%),The rate of GIN with gastric atrophy(GA)was 62.1%,intestinal metaplasia(IM)rate was 52.7%,H.pylori infection rate was 47.5%.According to the pathological results of biopsy,The lesions were divided into low-grade intraepithelial neoplasia(LGIN)group(111 cases)and high-grade intraepithelial neoplasia(HGIN)group(92 cases),There were statistically significant differences in gender(P = 0.001),diameter larger than 2.0 cm(P = 0.023),endoscopic morphology(P=0.001),GA(P = 0.008),IM(P = 0.001)and H.pylori infection(P =0.003).149 of 203 patients underwent surgical treatment,The postoperative pathology confirmed that there were 35 cases of LGIN,25 cases of HGIN,75 cases of early gastric cancer(EGC)and 14 cases of advanced gastric cancer(AGC).According to the postoperative pathologic results,149 cases were divided into GIN group(60 cases)and gastric cancer(GC)group(89 cases).Univariate analysis showed that there were significant differences in gender(P = 0.002),smoking(P = 0.038),drinking(P = 0.017),size larger than 2.0 cm(P = 0.007),depressed morphology(P = 0.000),GA(P = 0.002),IM(P =0.000),H.pylori infection(P = 0.002)between the two groups.Multivariate analysis indicated that size larger than 2.0 cm(OR = 4.114.95%Cl:1.248-13.565,P = 0.020),H.pylori infection(OR = 3.723,95%CI:1.301-10.653,P = 0.014);depressed morphology(OR-8.899,95%CI:1.863-42.514,P = 0.006)and HGIN diagnosed by endoscopy and biopsy(OR = 14.735.95%Cl:4.830 44.952,P = 0.000)were risk factors for the missed diagnosis of cancer on the GIN diagnosed by endoscopic forceps biopsy.Conclusion GIN was more frequently detected in male older than 60 years,the lesions were mainly located in the gastric antrum and gastric angle,the size was 1.0 cm or more,the main endoscopic morphology was flat,most of gastric mucosa with atrophy;LGIN and HGIN which were diagnosed by biopsy had the significant differences in gender,size larger than 2.0 cm,endoscopic morphology,GA,IM and H.pylori infection;For gastric intraepithelial neoplasia which were diagnosed by biopsy,sizes larger than 2.0cm,depressed morphology,H.pylori infection or HGIN confirmed by endoscopy and biopsy,we need to alert the possible missed diagnosis of cancer.