Don’t understand the endoscopic biopsy pathology report? Don’t worry, read here!

Author: Li Mingxian, Liu Taohua, Yang Haifeng, Guangdong Provincial Hospital of Traditional Chinese Medicine (Second Affiliated Hospital of Guangzhou University of Chinese Medicine)

Why was a biopsy recommended during gastroscopy?

Did you know? Gastric cancer is one of the most common cancers in the world, and my country is a high-incidence area for gastric cancer. Many patients are already in the middle and late stages when they are diagnosed, which makes treatment very difficult, and some are even too late to be treated. Therefore, people are paying more and more attention to gastroscopy, hoping to find problems earlier.

Speaking of gastroscopy, sometimes the doctor will ask you to do a biopsy. Why do you do this? Because gastroscopy is like using a high-definition camera to look at the mucosa of the esophagus, stomach and duodenum, but you can only see the surface. If you see something wrong, you will dig out a piece or several pieces of meat the size of a sesame seed and send them to the pathology department for further examination to see if it is benign or malignant. This is a gastroscopy biopsy, and the result of the biopsy is the pathology report. Don't worry, this process will not make you feel painful, at most you will feel a slight pull. Besides, the wound is so small that it will almost recover after an hour or two, and then you can start eating, or to be more precise, you can drink some porridge first.

Without professional knowledge, it is impossible to understand the endoscopic biopsy pathology report!

After reading the pathology report, some people may be confused: Why can't I find the words benign or malignant, but instead see incomprehensible professional terms? Next, let me explain it to you in detail.

First, you need to confirm whether the report is yours and where the specimen was taken from. Don’t make any mistakes! What does a pathology report contain?

(Photo credit: Photo by Li Mingxian)

What are the pathology reports for benign diagnoses?

"Infiltration of inflammatory cells" is the most common manifestation of various types of gastritis, which means that when the stomach is inflamed, white blood cells rush over to help. If the inflammation is mild, these cells will stay on the surface, accompanied by "erosion"; if the inflammation is severe, they will go deep inside, eventually leading to the formation of so-called "ulcers." In the long-term "anti-inflammatory struggle", white blood cells form a state of balanced confrontation with inflammation. Over time, this continuous immune response will lead to lymphoid tissue hyperplasia, which is also a typical feature of chronic gastritis.

The "degree of inflammation" is mainly determined by the number of inflammatory cells on the pathological section, while the "activity of inflammation" is more determined by the type of inflammatory cells involved in the "anti-inflammatory struggle". For example, the presence of a large number of neutrophils means that the inflammation is currently in the active stage. Both can be described as mild, moderate and severe. Even with mild inflammation, the stomach can sometimes be extremely painful, and severe cases can even cause perforation, so eliminating inflammation is a top priority. One of the main causes of gastritis and gastric ulcers is Helicobacter pylori (HP), so testing HP can more accurately catch the real culprit. If the report says "HP (+)", it means that there is Helicobacter pylori infection. You must quickly follow the doctor's advice for treatment and recheck whether Helicobacter pylori has been killed, so as to protect your stomach.

In addition, "polyps" are mostly related to inflammation. They are small fleshy lumps formed by long-term inflammatory stimulation. The types of polyps in this part include fundic gland polyps, inflammatory polyps, etc. They are usually benign and almost never become cancer. However, some polyps may also be tumorous lesions themselves, such as adenomatous polyps. However, most of them are usually benign, and only in some specific cases (such as when the diameter is greater than 2cm) will the possibility of cancer increase.

Which pathology reports require special attention?

"Glandular atrophy" and "intestinal metaplasia" mean that the small glands with secretory functions on the gastric mucosa are injured and slowly atrophy. When atrophy is severe, the function of the stomach will be affected, which is also related to Helicobacter pylori infection. Atrophic gastritis is usually divided into two types. One is non-metaplastic atrophy, which is mainly manifested by a decrease in the number of glands. This type of atrophy rarely becomes cancerous; the other is metaplastic atrophy. Please note that if "intestinal metaplasia" is mentioned in the pathology report, it means that the gastric mucosa becomes similar to the epithelium of the small intestine or large intestine, which represents the process and result of the self-repair of the stomach based on inflammation. Intestinal metaplasia is regarded as a precancerous lesion of the stomach. However, the nature of "glandular atrophy" and "intestinal metaplasia" themselves is not a tumor, so as long as the correct treatment and follow-up can be achieved, there is no need to worry too much.

Sometimes the diagnosis of "intraepithelial neoplasia" or "dysplasia" appears in the pathology report. The two are synonymous. Although they were originally defined as histologically identifiable precancerous lesions of gastric adenocarcinoma, they are now defined as a clear neoplastic lesion without evidence of stromal invasion. Pathologists will further classify them as low-grade or high-grade according to the extent of the lesions. Low-grade lesions are less harmful, and high-grade lesions are more harmful. If you see these words on the pathology report, you must see a doctor for a follow-up visit and further examination, and don't miss the best opportunity for early treatment.

What is the first thing to do after receiving a malignant pathology report?

In addition to the benign reports mentioned above, there are also common malignant reports of "adenocarcinoma" and "signet ring cell carcinoma". If you are unfortunate enough to see this type of pathology report, do not lose confidence, because a large part of early gastric cancer can be completely cured through endoscopic surgery or surgery. Therefore, the next thing to do is to find a clinician for further evaluation and correct treatment. I would like to add here that tumor staging includes the depth of tumor infiltration, the number of lymph node metastases and distant metastases. Only specimens that have been completely removed during surgery can be analyzed in this regard. Because gastroscopy only removes tissue on the surface of the mucosa, pathological examination cannot see its depth of infiltration, nor does it know whether there is lymph node metastasis, so it can only preliminarily characterize the tumor. As for the tumor staging, it is uncertain.

In summary, when reading the pathology report of gastroscopy biopsy, you should first check your basic personal information. If you encounter any questions or don't understand something, don't let your imagination run wild, lest you scare yourself, because for professional questions, the answers of professionals will be more reassuring. Afterwards, the patient should follow the doctor's advice and actively receive treatment. It is worth noting that good living habits, eating habits and emotional regulation also play a vital role in the treatment process.