ENDOSCOPIC FALSE-NEGATIVE FINDINGS IN MULTIFOCAL GASTRIC TUMORS

Abstract

Objective : Multiple neoplastic lesions are frequently present in patients with gastric tumors, thus raising the concern that lesions may be missed during endoscopic examination. We examined the findings of false-negative lesions of multifocal gastric tumors that were detected by high-resolution fiberoscopy over 3 years. Subjects : The subjects were 501 patients with gastric tumors who underwent endoscopic submucosal dissection (ESD) at our hospital. Results : Of the 501 cases, 94 with multiple lesions had more severe atrophy of the background mucosa (grade 0-2 or higher) and were older than the remaining 407 cases with a solitary lesion. Of the 94 cases with multiple lesions, 68 (72.3%) were referred from other hospitals, of which 30.7% were false-negative cases. Of these false-negative cases, 14.7% were found to be false negative by re-examination at our hospital. Of the 26 patients in whom multifocal gastric tumors were detected at our hospital, 29.8% were false-negative cases. False-negative findings were more common in lesions that were as small as 10 mm or lower in diameter or those that were characterized by unnoticeable color or visual shape. Conclusions : Multifocal gastric tumors occurred in older patients with severe atrophy of the gastric mucosa. Smaller lesions were more likely to yield false-negative results. Thus, gastric endoscopic examination should be carefully performed in cases of multifocal gastric tumors, and preoperative re-examination is likely to reduce the incidence of false-negative lesions.