Histopathological and Clinicopathological Correlation of Endoscopic Biopsies of Upper Gastrointestinal Tract Lesions

Upper gastrointestinal (GI) tract disorders are a major cause of morbidity and mortality worldwide. While endoscopic examination provides direct visualization of mucosal lesions, histopathological examination remains the gold standard for definitive diagnosis, particularly for distinguishing between non-neoplastic and neoplastic conditions.

This study aims to correlate clinical and endoscopic findings with histopathological diagnoses and to assess the prevalence of Helicobacter pylori in gastric biopsies.

A cross-sectional study was conducted at Gandhi Medical College and Associated Hospitals, Bhopal, from May 2023 to October 2024. A total of 100 patients undergoing upper GI endoscopy for various indications were included. Biopsies were taken from lesions in the esophagus, stomach, and duodenum. Tissue samples were routinely processed and stained with hematoxylin and eosin (H&E). Giemsa stain was used to detect Helicobacter pylori. Results: The most common clinical indications for endoscopy were abdominal pain and dyspepsia. Ulcer was the most frequent endoscopic finding (26 (26%)), followed by erosions (14 (14%)). On histopathological evaluation, non-neoplastic lesions predominated in younger age groups (41-50 years), while neoplastic lesions were more frequent in older patients (51-60 years) (p = 0.023). The esophagus was a common site for squamous cell carcinoma, while adenocarcinoma was the most frequent malignancy in the stomach. The diagnostic accuracy of endoscopy for detecting neoplastic lesions, using histopathological diagnosis as the reference standard, was 88%, with a sensitivity of 69%, a specificity of 96%, a positive predictive value (PPV) of 87%, and a negative predictive value (NPV) of 88%. Histopathology detected a higher proportion of neoplastic lesions (29%) compared to endoscopy (23%), highlighting its superior diagnostic accuracy.

Endoscopic biopsy is an essential diagnostic tool that correlates strongly with histopathological findings. While endoscopy is effective for initial screening and identifying suspicious growths, histopathology is crucial for confirming malignancy and identifying specific inflammatory conditions, such as H. pylori gastritis. Age and clinical symptoms such as dysphagia are significant predictors of neoplastic pathology in the upper GI tract.