Title:Gastric Cancer - Just One Bite: Is it Enough? Comparing the Use of Seven Biopsies with that of Only One Endoscopic Biopsy to Diagnose Advanced Gastric Cancer
Volume: 1
Author(s): Alexandre Dias Pelosi, Patricia Abrantes Luna, Gustavo Francisco de Souza Mello, Ivanir Martins de Oliveira, Maria Aparecida Ferreira, Luiz Claudio Santos Thuler, Kai-Uwe Lewandrowski and Rossano Kepler Alvim Fiorelli*
Affiliation:
- Department of Surgery, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
Keywords:
Gastric, cancer, biopsy, endoscopy, malignancy, digestive tract.
Abstract:
Background/Introduction: Gastric cancer is prevalent in the Brazilian population,
with diagnosis largely reliant on endoscopic biopsies. Current guidelines recommend a minimum
of seven endoscopic biopsies. However, advances in high-definition imaging, chromoendoscopy
technologies (such as narrow-band imaging [NBI]), and histopathological techniques suggest
that fewer biopsies might suffice. Validating this hypothesis could reduce the duration of examinations,
lessen the burden on pathologists, and minimize risks associated with multiple biopsies.
Methods: This prospective study evaluated the efficacy of various biopsy strategies in diagnosing
gastric lesions. A total of 106 lesions from 104 patients were examined over 14 months. The
study compared the diagnostic yield of the conventional seven biopsies (considered the gold
standard) with a single white-light biopsy, one NBI-guided biopsy, and a combination of both
white-light and NBI-guided biopsies.
Results and Discussion: When compared to the gold standard of seven biopsies, the single
white-light biopsy demonstrated a sensitivity of 90.1% (range 82.5-95.6%) and a specificity of
100% (range 47.8-100%). The NBI-guided biopsy yielded a sensitivity of 83.2% (range 74.4-
89.9%) and a specificity of 100% (range 47.8-100%). Combining both biopsy techniques
achieved a sensitivity of 96.1% and a specificity of 100%.
Conclusion: A single white-light biopsy was found to be nearly equivalent to the gold standard
of seven biopsies, using a 10% difference as the noninferiority criterion. Performing two biopsies-
one conventional and one NBI-guided-provided even greater accuracy, closely approximating
that of the gold standard.
