Predictive factors of histological upstaging and downstaging in gastric endoscopic submucosal dissection specimens

Endoscopic biopsies are insufficient for the correct diagnosis of gastric lesions since there has been described a discrepancy rate between endoscopy biopsies and endoscopic resection specimens of 25-32%. The aim of this study was to evaluate factors associated with upstaging and downstaging of biopsy results following gastric endoscopic submucosal dissection (ESD).

Retrospective, cohort study including consecutive patients who underwent gastric ESD after an initial upper endoscopy with the diagnosis of a gastric lesion harboring dysplasia or adenocarcinoma, confirmed by forceps biopsy.

A total of 215 patients were included, most patients were male (66.0%), with a mean age of 68 ± 8 years. Most lesions were located in the antrum (62.3%). Upstaging was observed in 70 patients (32.6%): 43 patients from low-grade dysplasia (LGD) to high-grade dysplasia (HGD); 9 from LGD to adenocarcinoma; and 18 patients from HGD to adenocarcinoma. Patients with upstaging had significantly larger lesions (18 vs 15 mm, p < 0.001) and had more frequently ulcerated lesions (10.0% vs 2.9%, OR 3.778, p = 0.045). Five patients (2.3%) had downstaging, from HGD to LGD. Patients with downstaging were significantly younger (61 ± 8 vs 68 ± 8 years, p = 0.035) and were more frequently active smokers (60.0% vs 14.3%, OR 9.000, p = 0.028).

The diagnostic discrepancy rate between the initial forceps biopsy and the ESD specimen was 34.9%. Patients with larger or ulcerated lesions were more likely to have an upstaging pathological result. Therefore, it is essential to perform a thorough evaluation of the lesions, including chromoendoscopy and magnification.