위용종의 내시경적 생검과 내시경적 절제술 후 병리학적 진단의 불일치

Abstract

Background : Gastric polyp is a descriptive term referring to mucosal prominence that protrudes beyond the flat lining of the stomach. Almost 90% of gastric polyps are hyperplastic polyps. Adenomatous polyps may contain focal carcinomatous foci or undergo carcinomatous changes. It is known that there is some degree of discordance between the results of endoscopic forceps biopsy and pathology of resected specimens. The aim of this study was to investigate the discordance in pathologic findings between endoscopic forceps biopsy and endoscopic resection specimen of gastric polyps. Methods : We reviewed endoscopic photographs and medical records of the patients who underwent endoscopic resection from April, 1996 through February, 2003. Results : A total of 85 cases of gastric polyps from 74 patients were reviewed. Male-to-female ratio was 1:1.96. Mean age was 59.9±10.8 years. Multiple polyps were observed in 10.8%. Gastric polyps occurred in the antrum most frequently (58.8%). Pathology results on resected specimens were as follows: tubular adenoma 45.9%, hyperplastic polyp 31.8%, inflammatory polyp 9.4%, hamartoma 3.5%, fundic gland polyp 2.4%, tubulovillous adenoma 2.4%, adenocarcinoma 2.4%, dysplasia 1.1%, and mucosal pseudolipomatosis 1.1%. Discordance rate between endoscopic biopsy and pathology of resected specimens was 27.1%. There was no relationship between the size of the polyp and concordance rate. Conclusions : There was considerable discordance in pathologic findings between endoscopic forceps biopsy and resected specimens. Approaches to review the histology of an entire polyp should be performed, especially when an adenoma is suspected.