Underestimation of endoscopic size in large gastric epithelial neoplasms
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Background/Aims: Endoscopic submucosal dissection (ESD) is an effective method for resecting gastric adenomas and adenocarcino-mas. A significant discrepancy was observed between endoscopic and pathological sizes in samples obtained from patients undergoingESD. This study elucidates the factors affecting size discrepancy after formalin fixation. Methods: The records of 64 patients with 69 lesions were analyzed, including 50 adenomas and 19 adenocarcinomas. Data on location,gross shape, histology, and size after fixation in formalin were collected. Results: The mean size of the resected specimen appeared to decrease after formalin fixation (37.5 mm prefixation vs. 35.8 mm post-fixation, p<0.05). The mean long axis diameter of the lesions was 20.3±7.9 mm prefixation and 13.4±7.9 mm postfixation. Size differ-ences in lesions smaller than 20 mm were significantly greater than those in lesions larger than 20 mm (7.6±5.6 mm vs. 2.5±5.8 mm,p<0.01). In multivariate analysis, a tumor size of ≥20 mm was found to be an independent factor affecting size postformalin fixation(p<0.05). Conclusions: The endoscopic size of lesions before ESD may be underestimated in tumors larger than 20 mm in size. Therefore, in-creased attention must be paid during ESD to avoid instances of incomplete resection.
Abstract
Background/Aims: Endoscopic submucosal dissection (ESD) is an effective method for resecting gastric adenomas and adenocarcino-mas. A significant discrepancy was observed between endoscopic and pathological sizes in samples obtained from patients undergoingESD. This study elucidates the factors affecting size discrepancy after formalin fixation. Methods: The records of 64 patients with 69 lesions were analyzed, including 50 adenomas and 19 adenocarcinomas. Data on location,gross shape, histology, and size after fixation in formalin were collected. Results: The mean size of the resected specimen appeared to decrease after formalin fixation (37.5 mm prefixation vs. 35.8 mm post-fixation, p<0.05). The mean long axis diameter of the lesions was 20.3±7.9 mm prefixation and 13.4±7.9 mm postfixation. Size differ-ences in lesions smaller than 20 mm were significantly greater than those in lesions larger than 20 mm (7.6±5.6 mm vs. 2.5±5.8 mm,p<0.01). In multivariate analysis, a tumor size of ≥20 mm was found to be an independent factor affecting size postformalin fixation(p<0.05). Conclusions: The endoscopic size of lesions before ESD may be underestimated in tumors larger than 20 mm in size. Therefore, in-creased attention must be paid during ESD to avoid instances of incomplete resection.
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