Pre- and post-ESD discrepancies in clinicopathologic criteria in early gastric cancer: the NECA–Korea ESD for Early Gastric Cancer Prospective Study (N-Keep)

Joon Mee Kim, Jin Hee Sohn, Mee Yon Cho, Woo Ho Kim, Hee Kyung Chang, Eun Sun Jung, Myeong Cherl Kook, So Young Jin, Yang Seok Chae, Young Soo Park, Mi Seon Kang, Hyunki Kim, Jae Hyuk Lee, Do Youn Park, Kyoung Mee Kim, Hoguen Kim, Youn Wha Kim, Seung Sik Hwang, Sang Yong Seol, Hwoon Yong JungNa Rae Lee, Seung Hee Park, Ji Hye You

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)


Background: Discrepancies in the clinicopathologic parameters pre- and post-endoscopic submucosal dissection (ESD) sometimes necessitate additional surgical resection. The aim of this study was to assess such discrepancies in clinicopathologic parameters before and after ESD in the context of reducing the risk of failure of curative ESD. Methods: Data on 712 early gastric cancer patients were prospectively collected from 12 university hospitals nationwide. The inclusion criteria were differentiated carcinoma <3 cm in size, no ulceration, submucosal invasion <500 μm, and no metastasis. Clinicopathologic factors were compared retrospectively. Results: The discrepancy rate was 20.1 % (148/737) and the most common cause of discrepancy was tumor size (64 cases, 8.7 %). Ulceration, undifferentiated histology, and SM2 invasion were found in 34 (4.6 %), 18 (2.4 %), and 51 cases (6.9 %), respectively. Lymphovascular invasion (LVI) was observed in 34 cases (4.6 %). Cases with lesions exceeding 3 cm in size showed more frequent submucosal invasion, an elevated gross morphology, and upper and middle locations (p < 0.05). In the cases with ulceration, depth of invasion (DOI) was deeper than in the cases without ulceration (p = 0.005). Differentiation was correlated with DOI and LVI (p = 0.021 and 0.007). DOI was correlated with tumor size, ulceration, differentiation, LVI, gross type, and location. There were statistically significant differences between mucosal cancer cases and submucosal cancer cases in tumor size, differentiation, ulceration, LVI, and location. Conclusions: The overall discrepancy rate was 20.1 %. To reduce this rate, it is necessary to evaluate the DOI very cautiously, because it is correlated with other parameters. In particular, careful checking for SM-invasive cancer is required due to the high incidence of LVI irrespective of the depth of submucosal invasion.

Original languageEnglish
Pages (from-to)1104-1113
Number of pages10
JournalGastric Cancer
Issue number4
Publication statusPublished - 2016 Oct 1
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2015, The Author(s).


  • Discrepancy
  • Early gastric cancer
  • Endoscopic submucosal dissection
  • Indication
  • Preoperative diagnosis

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research


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