저도 이형성을 보인 위 점막병변에서 내시경 점막절제술의 진단적 의의

Abstract

Gastric adenoma with high grade dysplasia has been regarded as a premalignant lesion. Surgical or endoscopic mucosal resection (EMR) was recommended to treat high grade dysplasia. On the other hand; low grade dysplasia have been regarded as relatively low risk of malignant transformation. However; variable histological grades might be presented at single dysplastic lesion and so endoscopic forceps biopsy (EFB) might not represent whole pathologic lesion. Thus we evaluated the histologic discrepancy between EFB and EHR in patients with low grade dysplasia. We reviewed retrospectively 142 patients (M:F=84:58) undergone EMR who had been diagnosed as low grade dysplasia by EFB from 1998 to 2005. Mean age of the patients was 62.6 years old (28~77 years). Of 142 patients; the pathologic examination through the EMR showed 7 cases (4.9%) of adenocarcinoma; 15 cases (10.6%) of high grade dysplasia; 102 cases (71.8%) of low grade dysplasia; 4 cases (2.8%) of hyperplastic polyp; 14 case (9.9%) of chronic gastritis. Twenty two cases (15.5%) among 142 cases were upgraded in the histologic staging to carcinoma or high grade dysplasia. We found in reddish surface color endoscopic features; having statistically significant relationships with adenocarcinoma at the final pathological diagnosis. In conclusion; although low grade dysplasia was diagnoses initially by EFB; endoscopic mucosal resection might be need to confirm an accurate diagnosis and treatment; especilly; when the lesion was reddish surface color. The reason is due to that focal adenocarcinoma can be exit around low grade dysplasia lesion.