AUTHOR=Xiao Jun , Yu Chao , Chen Jing , Sun Renhu , Jin Hailin , Liu Chunyang , Wang Yaohui , Sun Zhiguang 

TITLE=Endoscopic or Follow-up Treatment for Gastric Indeterminate Tumors Is the Preferred Method of Management

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.947810

DOI=10.3389/fonc.2022.947810

ISSN=2234-943X

ABSTRACT=Background Endoscopic forceps biopsy (EFB) is deficient in the clarity of indeterminate tumor diagnosis. When the presence of early gastric cancer (EGC) is macroscopically suspected, but biopsy pathology fails to give a diagnosis of neoplasia, it causes problems in clinical management. The purpose of this study was to discuss the outcome of gastric indeterminate tumors and the clinical factors associated with predicting EGC. 
Methods The medical records of 209 patients diagnosed with gastric indeterminate neoplasia by biopsy forceps were retrospectively studied. Initial endoscopic findings were analyzed and predictors of EGC were evaluated. 
Results The final pathological diagnosis in 209 patients included adenocarcinoma (n=7), high-grade intraepithelial neoplasia (n=11), low-grade intraepithelial neoplasia (n=21), and non-neoplastic (n=170). Multivariate analysis showed that older age (OR = 1.78; 95% CI = 1. 17-2.71; p = 0.008), patients undergoing narrow band imaging (NBI) (OR = 3.40; 95% CI = 1.37-8.43; p = 0.008), and surface erosion (OR = 3.53; 95% CI = 1.41-8.84; p = 0.007) were associated with escalation group was significantly associated with risk. Univariate logistic regression analysis showed that among patients with NBI, the presence of demarcation line (DL) (OR = 24.00; 95% CI = 4.99-115.36; p < 0.0001), microvascular (MV) pattern irregularity (OR = 9.129; 95% CI = 2.36-35.34; p = 0.001) and the presence of white opaque substance (WOS) (OR = 10.77; 95% CI = 1.14-101.72; p=0.038) were significant risk factors. 
Conclusions For gastric indeterminate tumors, older patient age, lesion surface with erosion, clear DL visible under NBI observation, presence of WOS, and irregular microvascular (MV) are suggestive of the high possibility of neoplasia and need to be focused on and may benefit more from endoscopic resection treatment as opposed to simple endoscopic follow-up.