A meta-analysis of factors predicting pathological upstaging of gastric low-grade intraepithelial neoplasia post endoscopic resection
10.3760/cma.j.cn321463-20231024-00431
- VernacularTitle:活检病理胃低级别上皮内瘤变内镜下切除术后病理诊断升级相关危险因素的meta分析
- Author:
Fangning WANG
1
;
Shutong ZHOU
1
;
Peng LI
1
Author Information
1. 首都医科大学附属北京友谊医院消化内科 国家消化系统疾病临床医学研究中心 首都医科大学消化病学系 消化疾病癌前病变北京市重点实验室，北京 100050
- Publication Type:Journal Article
- Keywords:
Stomach neoplasms;
Endoscopic resection;
Low-grade intraepithelial neoplasia;
High-grade intraepithelial neoplasia;
Risk factors;
Meta-analysis
- From:
Chinese Journal of Digestive Endoscopy
2025;42(6):480-486
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To identify the risk factors that predict pathological upstaging of low-grade intraepithelial neoplasia (LGIN) or low-grade dysplasia (LGD) in forceps biopsy after endoscopic resection.Methods:A systematic search of Web of Science, Embase, PubMed and Cochrane Library was conducted using the terms "Risk Factor" "Low-Grade Dysplasia or Low-Grade Intraepithelial Neoplasia" "gastric or stomach" with a deadline of October 2022. Observational studies related to risk factors for biopsy pathology diagnosis of gastric LGIN or LGD lesions with pathology escalation after endoscopic resection were included. Meta-analysis was performed using random-effects models to calculate pooled odds ratio ( OR). Results:Fifteen studies were identified on pathologic upstaging associated with 5 different risk factors: erythema, lesion diameter, depressed lesions, nodularity, and lesion location. Factors that significantly increase the risk of upgrading the pathological diagnosis after endoscopic resection included erythema ( P<0.01, OR=2.87, 95% CI: 1.94-4.25), lesion diameter ( P<0.01, OR=2.50, 95% CI: 1.85-3.37), depressed morphology ( P=0.02, OR=1.70, 95% CI: 1.09-2.64), and nodularity ( P<0.01, OR=2.95, 95% CI: 1.81-4.81). The risk of pathologic diagnostic escalation after endoscopic resection was similar for lesions in the upper 1/3 of the stomach compared to lesions in the lower 1/3 of the stomach ( P=0.86, OR=1.03, 95% CI: 0.72-1.47), whereas the risk of pathologic diagnostic escalation for lesions in the middle 1/3 of the stomach was even lower ( P<0.01, OR=0.75, 95% CI: 0.60-0.93). Conclusion:Several endoscopic factors, including lesion diameter, location and surface morphology, are associated with the pathologic upstaging of LGIN/LGD on pre-treatment forceps biopsy. Clinical attention should be paid to the risk of pathological diagnosis upgrading after endoscopic resection of large lesions, including redness, depression, and nodular surface lesions in the lower 1/3 of the stomach.
