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Clinical Approach for 30 Patients with Gastric Cancer on First Biopsy but Negative Results on Re-Biopsy at Referred Hospital

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Kim, Jeong; Lee, Jun Haeng, Professor; Kim, Jae J., Professor; Rhee, Jong Chul, Professor; Kim, Sung, Professor

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S52
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: STOMACH
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Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea and Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: After referral of the patients with pathologically confirmed gastric cancers, re-examination is frequently performed to determine further management plans. However, biopsy results at referred hospital may be different from the original pathology report. Some patients may have persistently negative results on repeated biopsies. In this study, we analyzed the clinical results of 30 patients with this challenging problem (gastric cancer in first biopsy but no evidence of malignancy in the re-biopsy after referral).

Methods: From January 2003 to March 2005, we analyzed 30 patients with gastric cancer diagnosed on outside biopsy (28 adenocarcinomas and 2 signet cell carcinomas) and negative results on first biopsy at Samsung Medical Center, a tertiary hospital in Seoul, Korea. We recommended surgery or endoscopic mucosal resection depending on the characteristics of the lesions. Medical records, endoscopic images, and pathology reports were retrospectively reviewed.

Results: On our first biopsy, 7 patients had adenoma, 2 patients had atypical gland, and the remaining 21 patients had nonspecific findings. Without evidence of cancer at first biopsy, endoscopic mucosal resection (EMR) was performed in 8 patients, and the results were EGC in 4 patients, adenoma in 3 patients, gastritis in 1 patient. In the second or third biopsies of 20 patients, gastric cancer was confirmed in 8 patients (40%), and surgery (n = 7) and EMR (n = 1) was done. In 8 patients with no evidence of cancer in at least 2 repeated biopsies, surgery was performed, and the results were gastric cancer in 6 patients, MALT lymphoma in 1 patient, no residual cancer in 1 patient. In summary, the final results of 30 patients were early gastric cancer in 17 patients (57%), MALT lymphoma in 1 patient, adenoma with high grade dysplasia in 5 patients, no evidence of residual cancer in 2 patients, and unconfirmed in 5 patients (follow up loss in 4 patients, and waiting for 4th biopsy in 1 patient).

Conclusions: When patients are referred with biopsy-proven gastric cancer, one negative result on the re-biopsy is not enough to exclude malignancy. In a majority of patients with this discrepancy, the final diagnosis is early gastric cancer. Endoscopic mucosal resection can be a good option for both diagnostic and therapeutic purpose.

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