Analysis of clinicopathologic characteristics and risk factors for missed diagnosis in synchronous multiple early gastric cancer.

Abstract

Aims: This study aimed to enhance synchronous multiple early gastric cancer (SMEGC) detection by analyzing clinicopathological features, correlations between main/minor lesions in SMEGC and gastric high-grade intraepithelial neoplasia (GHGIN), and identifying risk factors for missed diagnoses.

Method: A cross-sectional analysis included 130 patients with SMEGC or GHGIN undergoing endoscopic submucosal dissection (ESD) at Nanjing Drum Tower Hospital. Clinicopathological characteristics were evaluated, with lesions classified as main or minor. Correlations between lesions were assessed based on size, location, endoscopic morphology, histopathology, invasion depth, and vascular invasion. Risk factors for missed diagnoses were analyzed.

Results: Of 2580 patients treated with ESD, 130 with SMEGC or GHGIN were included in this study. The sizes of the main and minor lesions were positively correlated (r = 0.658, p < 0.001). The main and minor lesions showed moderate consistency in pathological type (kappa = 0.421, p < 0.001) and low consistency in endoscopic morphology, depth of invasion, and longitudinal position (kappa < 0.4, p < 0.05). Of 130 included patients, diagnoses for 37 were missed. Small and non-primary lesions were independent risk factors for missed lesions. We also found that the hospital grade at first gastroscopy was a risk factor for missed diagnosis.

Conclusions: Endoscopists should be aware of the risk factors associated with SMEGC and consider the correlation between the main and minor lesions to prevent the oversight and misdiagnosis of SMEGC.