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Poorly differentiated component in gastric pinch biopsies predicts submucosal invasion

Sun-Mi Lee1, Sun Yang2, Mee Joo3, Kyoung-Mee Kim24*, Cheol Keun Park4, Soomin Ahn4, Byung-Hoon Min2, Jun Haeng Lee2, Seonwoo Kim5, Jong Chul Rhee2, Jae J Kim2* and Gregory Y Lauwers6

Author Affiliations

1 Department of Pathology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

2 Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea

3 Department of Pathology, Ilsan Paik Hospital, College of Medicine, Inje University, Daewha-Dong, Ilsan-Gu, Goyang-Si, Gyeonggi-Do, Korea

4 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

5 Biostatistics Unit, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

6 Department of Pathology, Massachusetts General Hospital, Boston, MA, USA

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Diagnostic Pathology 2014, 9:34  doi:10.1186/1746-1596-9-34

Published: 20 February 2014



Endoscopic resection has become standard therapy for selected patients with early gastric carcinoma (EGC). However, the preoperative diagnostic accuracy for excluding submucosal (SM) invasion is not precise. Moreover, histologic features predicting SM invasion in gastric carcinomas (SMiGC) have not been studied extensively.


Pre-treatment gastric biopsies from 60 patients with SM invasion who underwent endoscopic resection were reviewed and compared to 58 biopsies of lesions confirmed to be intramucosal carcinomas (IMC). For validation of the results, an independent cohort consisting of 616 gastric biopsies confirmed as EGC were analyzed. For statistical analyses, χ-square test, Fisher’s exact test and multiple logistic progression tests were used.


In the biopsy specimens of patients with SMiGCs, differentiated histology, poorly differentiated component, wisps of muscularis mucosa, tumor cribriforming, papillary architecture, desmoplasia and intraglandular eosinophilic necrotic debris (IEND) were observed in 96.7%, 36.7%, 16.7%, 16.7%, 23.3%, 40%, and 46.7% of cases, respectively, while the same features were observed in 100%, 5.2%, 0%, 1.7%, 5.2%, 19%, and 22.4% of biopsies with IMC. In multivariate analyses, poorly differentiated component [odds ratio (OR), 9.59, p = 0.002], IEND [OR, 6.23, p = 0.012], tumor cribriforming [OR, 4.66, p = 0.03] and papillary architecture [OR, 5.52, p = 0.018] were significantly associated with the detection of SM invasion. In the validation cohort, poorly differentiated component (p = 0.003) and papillary architecture (p = 0.008) remained significant.


Poorly differentiated component and papillary architecture are significant histopathologic predictors of SM invasion in pretreatment gastric biopsies of lesions considered for endoscopic therapy. Additional prospective studies are warranted to confirm our findings.

Virtual slide

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Gastric cancer; Biopsy; Histologic; Submucosa; Invasion; Endoscopic resection