Factors Predicting Pathological Upstaging of Gastric Low-Grade Dysplasia Post Endoscopic Resection: A Systematic Review and Meta-Analysis

Abstract

Abstract Background Some lesions of gastric low-grade dysplasia (LGD) or low-grade intraepithelial neoplasia (LGIN) on forceps biopsy (FB) are diagnosed as gastric cancer or high-grade dysplasia (HGD)/high-grade intraepithelial neoplasia (HGIN) after endoscopic resection. This systematic review and meta-analysis aimed to investigate the risk factors that predict pathological upstaging to HGD/HGIN or LGD/LGIN in FB. Methods We conducted a systematic search of Medline, EMBASE, and Web of Science for observational studies that included the terms “risk factor,” “low-grade dysplasia,” or “low-grade intraepithelial neoplasia.” Results We identified 15 studies on pathologic upstaging associated with 5 different risk factors: erythema, lesion diameter, depressed lesions, nodularity, and lesion location. We observed that factors that significantly increase the risk of early diagnosis of pathological stages included erythema (Odds Ratio [OR], 2.87; 95% confidence interval [CI], 1.94–4.25), lesion diameters (OR, 2.50; 95%CI, 1.85–3.371), depressed lesions (OR, 1.61; 95%CI, 1.00– 2.59), and nodularity (OR, 2.95; 95%CI, 1.81– 4.811). A significant risk reduction factor was lesions located in the middle 1/3 of the stomach (OR, 0.75; 95%CI, 0.60– 0.93). No significant associations were detected between the pathological upstaging diagnosis and Helicobacter pylori infection status and ulceration. Conclusion Several endoscopic factors, including lesion diameter and surface morphology, are associated with the pathologic upstaging of LGD/LGIN on pre-treatment forceps biopsy. These findings enhance our understanding of lesion diagnosis of LGD/LGIN using forceps biopsy.