Abstract
Background and Study Aims: The correct histological diagnosis of gastric borderline adenomas is often difficult,
especially in excluding malignancy, since the usual diagnostic methods, such as radiography
and histological examination of forceps biopsy specimens, are of limited accuracy.
The aim of this study was to retrospectively analyze the value of endoscopic mucosal
resection in establishing the correct diagnosis of boderline adenomas.
Patients and Methods: Fifty patients diagnosed as having borderline adenomas of the stomach were included
in the study. None of the tumors had a conclusive diagnosis of carcinoma on endoscopic
biopsy. Following endoscopic mucosal resection, the histological results of biopsy
and resected specimens were analyzed.
Results: Fourteen borderline adenomas were finally diagnosed as containing early gastric cancer
type IIa (well-differentiated tubular adenocareinoma) after endoscopic mucosal resection,
of the remaining 36 tubular adenomas, six represented mild dysplasia, 24 moderate
dysplasia, and six severe dysplasia. Most parts of the 14 adenomas containing early
gastic cancers had regions of structural atypia, and cellular atypia was moderate
in all. Seven of 14 cancers were completely resected, all patients being tumor-free
after a follow-up of 33-61 months.
Conclusions: These results suggest that diagnosing borderline adenoma on the basis of radiographic
and endoscopic-bioptic findings is generally unreliable, because biopsy specimens
may not be representative of the entire lesion. Borderline adenomas of the stomach
should be completely resected by endoscopic mucosal resection to obtain a final diagnosis
and - depending on the size and type of the lesion - possibly also definitive treatment.
