Endoscopic and histological diagnosis on upper gastrointestinal cancer screening

Screening endoscopy for upper gastrointestinal cancer has come into wide use in Japan. We aim to clarify the limitation of its endoscopic diagnosis and contribution of histological biopsy on routine endoscopy.

For consecutive 1184 patients (696 men and 488 women, average age of 57 years) undergoing routine esophagogastroduodenoscopy, we prospectively evaluated endoscopic diagnosis with regard to grade of malignancy (definitely cancer, E5; probably cancer, E4; dysplasia/adenoma or indeterminate malignant, E3; probably benign, E2; and definitely benign, E1). Histological grade was defined as H5 (cancer), H4 (probably cancer), H3 (dysplasia/ adenoma or indeterminate malignant), H2 (probably benign), and H1 (definitely benign) in 267 patients undergoing endoscopic forceps biopsy. We analyzed the accuracy of endoscopic and histological biopsy diagnosis.

Incidence of neoplastic lesions including H3, H4, and H5 was 0% in E1 (0/978), 2% in E2 (3/132), 19% in E3 (6/31), 33% in E4 (3/9), and 100% in E5 lesions (34/34). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endoscopic diagnosis for these neoplastic lesions were 94%, 97%, 58%, 99%, and 97%, respectively.

Better awareness of its endoscopic features and appropriate endoscopic biopsy is essential in the diagnosis of upper gastrointestinal cancer on screening endoscopy.