Clinical Implications of Histologic Heterogeneity in Endoscopic Submucosal Dissection Specimens for Differentiated-Type Early Gastric Cancer.
- 1Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 2Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 3Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. [email protected].
Abstract
Purpose
The clinical implications of histologic heterogeneity, defined as differentiated-type early gastric cancer (EGC) containing undifferentiated components, in endoscopic submucosal dissection (ESD) specimens remain unclear. We investigated the association of histologic heterogeneity and biopsy-detected poorly differentiated components with lymph node metastasis in differentiated-type EGC.Materials and methods
This retrospective study included 858 patients who underwent gastrectomy after ESD for differentiated-type EGC. Histologic heterogeneity in ESD specimens and its association with clinicopathological features, including lymph node metastasis, were analyzed. In addition, 88 pre-treatment biopsy specimens were reviewed for the presence of poorly differentiated components.Results
Histologic heterogeneity was identified in 252 (29.4%) patients, and lymph node metastasis was detected in 46 (5.4%) patients. Histologic heterogeneity was significantly associated with higher frequencies of lymphatic invasion (73.4% vs. 50.8%, P<0.001) and lymph node metastasis (8.3% vs. 4.1%, P=0.013). Among patients with available biopsy specimens, poorly differentiated components identified on biopsy were observed only in lesions with histologic heterogeneity in ESD specimens and were associated with a higher frequency of lymph node metastasis (37.5% vs. 2.5%, P=0.005).Conclusions
Histologic heterogeneity in ESD specimens was associated with adverse pathological features, including lymphatic invasion and lymph node metastasis. These findings support the detailed documentation of histologic heterogeneity in ESD pathology reports and minor poorly differentiated components in biopsy specimens to assist in risk stratification and individualized treatment planning for differentiated-type EGC.
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BibTeX
@article{yoon2026clinical,
title = {{Clinical Implications of Histologic Heterogeneity in Endoscopic Submucosal Dissection Specimens for Differentiated-Type Early Gastric Cancer.}},
author = {Ha-Jun Yoon and Tae-Se Kim and Hyuk Lee and Byung-Hoon Min and Yang Won Min and Jun Haeng Lee and Kyoung-Mee Kim and Soomin Ahn},
journal = {Journal of gastric cancer},
year = {2026},
month = oct,
doi = {10.5230/jgc.2026.26.e45},
url = {https://europepmc.org/article/MED/42845258},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Clinical Implications of Histologic Heterogeneity in Endoscopic Submucosal Dissection Specimens for Differentiated-Type Early Gastric Cancer.
AU - Ha-Jun Yoon
AU - Tae-Se Kim
AU - Hyuk Lee
AU - Byung-Hoon Min
AU - Yang Won Min
AU - Jun Haeng Lee
AU - Kyoung-Mee Kim
AU - Soomin Ahn
PY - 2026
DA - 2026/10/01
JO - Journal of gastric cancer
DO - 10.5230/jgc.2026.26.e45
UR - https://europepmc.org/article/MED/42845258
AB - Purpose The clinical implications of histologic heterogeneity, defined as differentiated-type early gastric cancer (EGC) containing undifferentiated components, in endoscopic submucosal dissection (ESD) specimens remain unclear. We investigated the association of histologic heterogeneity and biopsy-detected poorly differentiated components with lymph node metastasis in differentiated-type EGC.Materials and methods This retrospective study included 858 patients who underwent gastrectomy after ESD for differentiated-type EGC. Histologic heterogeneity in ESD specimens and its association with clinicopathological features, including lymph node metastasis, were analyzed. In addition, 88 pre-treatment biopsy specimens were reviewed for the presence of poorly differentiated components.Results Histologic heterogeneity was identified in 252 (29.4%) patients, and lymph node metastasis was detected in 46 (5.4%) patients. Histologic heterogeneity was significantly associated with higher frequencies of lymphatic invasion (73.4% vs. 50.8%, P<0.001) and lymph node metastasis (8.3% vs. 4.1%, P=0.013). Among patients with available biopsy specimens, poorly differentiated components identified on biopsy were observed only in lesions with histologic heterogeneity in ESD specimens and were associated with a higher frequency of lymph node metastasis (37.5% vs. 2.5%, P=0.005).Conclusions Histologic heterogeneity in ESD specimens was associated with adverse pathological features, including lymphatic invasion and lymph node metastasis. These findings support the detailed documentation of histologic heterogeneity in ESD pathology reports and minor poorly differentiated components in biopsy specimens to assist in risk stratification and individualized treatment planning for differentiated-type EGC.
SN - 2093-582X
SN - 2093-5641
ER -